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She is Ming Health Cultivation Center REQUEST/CONSENT TO RELEASE RECORDS & INFORMATION I, (print full name), born on, SSN, Phone, hereby authorize: She is Ming Health Cultivation Center 2009 Cedar
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2009 Shen SSN infoshenminghealth Summaries Cultivation reliance Photocopy herein aforementioned Referral Tel expire implication disclosure fulfillment recipient Coordination Approximate Intake copying disclose

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