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This AUTHORIZATION FOR RELEASE OF INFORMATION may be signed by me in multiple counterparts and if it is each such counterpart shall constitute a signed original. My signature on a carbon copy facsimile copy scanned copy pdf file or other reproduction of this document shall be as valid and binding as a signed original. Signature Printed Name Date 20 ARRT ID Form January 2017 FAX ATTENTION Ethics Requirements Department American Registry of Radiologic Technologists 651. AUTHORIZATION FOR...
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