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AUTHORIZATION TO USE AND/OR DISCLOSE PROTECTED HEALTH INFORMATION 1. I hereby authorize Beth Israel Deaconess Hospital-Plymouth, 275 Sandwich Street, Plymouth, MAto use or disclose the following health information
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Document Date: 2014-07-10 11:25:07
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AUTHORIZATION TO USE AND/OR DISCLOSE PROTECTED HEALTH INFORMATION 1. I hereby authorize Beth Israel Deaconess Hospital-Plymouth, 275 Sandwich Street, Plymouth, MAto use or disclose the following health information