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All Rights Reserved. PAGE 1 REQUIRED SIGNATURE ON PAGE 2 APPLICANT AUTHORIZATION TO RELEASE AND DISCLOSE MEDICAL INFORMATION By my signature I authorize GlaxoSmithKline as well as McKesson Specialty Arizona Inc. MSAZ and any other companies that GlaxoSmithKline uses to administer Bridges to Access the Program to do the following 1 se any information that I provide in my application for the Program for the purpose of helping me receive GlaxoSmithKline products under the U Program or to administe ...

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