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97 per page from 1-20 0. 66 for pages 101 Plus taxes REFUSAL TO AUTHORIZE USE AND/OR DISCLOSURE However if I have been asked to sign this form in order to authorize the disclosure of my health information for purposes related to research or for other reasons I understand that WellStar Health System may decline to treat me if I refuse to sign this information only if 1 the treatment would be related to a research project and this authorization is for the use or disclosure of my health informatio ...

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