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Get Ct Information Form 2012-2024

O release to the used or disclosed (excluding psychotherapy notes). I understand that under applicable Recipient specified above copies of the information requested in Sections 3 and 4 of this law, the information disclosed under this authorization may be subject to further form and I give permission to the Recipient to release that information, whether obtained disclosure by the recipient and thus, may no longer be protected by federal privacy by this or an additional authorization required by.

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