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Your request must state the specific restriction requested and to whom you want the restriction to apply. Healthcare providers. This authorization will remain in effect until I revoke it in writing by notifying the Privacy Officer at the Perry Medical Clinic 401 Northwood Drive Centre Alabama. I may revoke this authorization at any time provided that the revocation is in writing to the Privacy Officer at the Perry Medical Clinic 401 Northwood Drive Centre Alabama. I may request a copy of this...
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401 Northwood Drive Centre is a commercial building located at 401 Northwood Drive.
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