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Jefferson Place Health & Rehabilitation 1705 Herr Lane Louisville, KY 402226545 (P) (502) 4265600 (F) (502) 4293193 REQUEST TO RESTRICT USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION You have
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Note: Please note that "Jefferson Place Health amp" is a fictional organization used for the purpose of this example, and any resemblance to real establishments is purely coincidental.

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