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THE GEORGIA CENTER FACIAL PLASTIC SURGERY AND LASER AESTHETICS 613 PONDER PLACE EVANS GA 30809 706. Right to Terminate or Revoke Authorization You may revoke or terminate this authorization by submitting a written revocation to Acknowledgement Form I acknowledge receipt of this Notice of Privacy Rights which I have reviewed and given my permission to THE GEORGIA CENTER to use and disclose my health information in accordance with it. Uses and Disclosures Treatment - Your health information may...
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