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Revised: 11/2015 Consent for Chemotherapy/Biotherapy, Condition for which treatment is proposed: 1. I hereby authorize my physician, Dr, and/or such other staff physicians or resident physicians as
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Penn State Hershey is a medical center and college of medicine located in Pennsylvania.
Any organization or individual who has a financial relationship with Penn State Hershey may be required to file.
Penn State Hershey may be filled out online or through a paper form provided by the institution.
The purpose of Penn State Hershey is to disclose any financial relationships that may potentially influence research, education, and clinical care activities.
Information such as financial interests, gifts, grants, and collaborations with external entities must be reported on Penn State Hershey.
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