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Get Anatomical Donation Program Medical Records ... - Utoledo

E for use by the University for educational, research, and scientific purposes. In order to increase the educational, research, and scientific value of such gift subsequent to my death, I authorize and request any hospital or institution in which I was a patient at any time within two years prior to my death, and any physician who at any time attended me within two years prior to my death, to furnish any and all records concerning my case history, treatment, and examination that I may have recei.

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