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State of California Health and Human Services Agency California Department of Public Health STERILIZATION CONSENT FORM NON-FEDERALLY FUNDED NOTICE YOUR DECISION AT ANY TIME NOT TO BE STERILIZED WILL NOT RESULT IN THE WITHDRAWAL OR WITHHOLDING OF ANY BENEFITS PROVIDED BY PROGRAMS OR PROJECTS RECEIVING FEDERAL FUNDS. CONSENT TO STERILIZATION STATEMENT OF PERSON OBTAINING CONSENT I have asked for and received...
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consent form pm 330
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