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I also understand that I may revoke this consent by written request at any time with this doctor. If revoked it is understood by all parties that all information released prior to being notified of such revocation was made with my consent. Yaklich/Jennings to the release of medical records for the above specified individual. Please read carefully I authorize the release of any medical or other information necessary to process insurance claims for any services furnished to me. Dr. Bradley R....
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