Form 701 docx 2025

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The document is an informed consent form for the Mississippi Breast and Cervical Cancer Early Detection Program (MSBCCEDP), which aims to facilitate free screenings for breast and cervical cancer for eligible individuals. It outlines the program's purpose, services provided, confidentiality of information, and the voluntary nature of participation. Patients must consent to share their health information with the program and understand that they can withdraw their consent at any time. The form also includes instructions for completion and retention.

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