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Get OK 08HI003E 2008-2024

Dress of the individual/organization to release records to give my health care records described below to: Name and address of the individual/organization requesting records for the following purposes: By initialing the spaces below, I specifically give permission to release the following health information: Client or client's personal representative must initial next to the information to be released. HIV/AIDS related information and records Mental health records Genetic testing and records.

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