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Get Il Hfs 3806d 2009

Ealth information without your permission except in certain situations. If you sign this form, you are giving HFS permission to share your health information that HFS has with the person you indicate below. This authorization is voluntary. Right to revoke : If you decide you do not want HFS to share your health information any longer, sign the revocation at the end of this form and give this form to HFS. If HFS has shared your health information for a research study, HFS may continue to.

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