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PATIENT CONSENT FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION With my consent, BRANDYWINE MEDICAL ASSOCIATES, may use and disclose protected health information (PHI) about me to carry out
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TPO ASSOCIATESs ADVICES disclosures BRANDYWINE discloses Becks reliance reminders consenting restrict healthcare revoke pertaining revise PHI DISCLOSURE forwarding revised restrictions reserves disclose

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