PRIVACY ACT STATEMENT - HEALTH CARE RECORDS THIS FORM IS NOT A CONSENT FORM TO RELEASE OR USE HEALTH CARE INFORMATION PERTAINING TO YOU. 1. AUTHORITY FOR COLLECTION OF INFORMATION INCLUDING SOCIAL SECURITY NUMBER (SSN) S - FIU - Document - PDFSEARCH.IO

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	PRIVACY ACT STATEMENT - HEALTH CARE RECORDS THIS FORM IS NOT A CONSENT FORM TO RELEASE OR USE HEALTH CARE INFORMATION PERTAINING TO YOU. 1. AUTHORITY FOR COLLECTION OF INFORMATION INCLUDING SOCIAL SECURITY NUMBER (SSN) S Add to Reading List Document Date: 2015-06-15 05:39:08 Open Document File Size: 302,60 KB Share Result on Facebook

PRIVACY ACT STATEMENT - HEALTH CARE RECORDS THIS FORM IS NOT A CONSENT FORM TO RELEASE OR USE HEALTH CARE INFORMATION PERTAINING TO YOU. 1. AUTHORITY FOR COLLECTION OF INFORMATION INCLUDING SOCIAL SECURITY NUMBER (SSN) SAdd to Reading List