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Get Da Form 5018 1981-2024

T I, , this day of 19 , (client's full name) do hereby voluntarily consent to the release of the following information by (name of installation ADAPCP) pertaining to my identity, diagnosis, prognosis, or treatment from any Army record maintained in connection with alcohol or other drug abuse education, training, treatment, rehabilitatiton, or research to for the purpose of namely, (extent or nature of information to be disclosed) SECTION B - EXPIRATION/REVOCATION (Check applicable para.

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