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I will not request records/health information from the provider/office. PATIENT With my parent s consent I am entering a confidential physician patient-relationship with the providers of CTOA physician nurse practitioner physician assistant. COMPLETE SECTION B or C I the undersigned as the parent or legal guardian of minor patient give permission to CTOA to provide medical treatment. STAFF If Section C is completed - Please have minor complete the bottom portion of a new Release of PHI Form.....
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