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PARENTS OR GUARDIAN PROHIBITED; PARTICIPATION IN PROCEEDINGS; RIGHT TO COUNSEL; HEARSAY EVIDENCE; ASSISTANCE IN PREPARING PETITION; CONFIDENTIALITY; CONTENTS
Consent to Release Information. A copy of your confidential medical records can be provided to your insurance, or sent to an employer, another university,
authorization for release of pennsylvania emergency medical
Jan 2, 2019 If this authorization is signed by someone who is not the patient listed at the top of this form, provide proof and a description of the signer
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