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However this authorization cannot be used to share psychiatric notes. AHL will not condition my enrollment or eligibility for insurance benefits on my provision of this ABJ8299-1 5/2017 AHL does not guarantee that Recipient will not redisclose my health information to a third party. Notice of revocation to AHL at the address listed above. The revocation will be effective upon AHL s receipt of my written notice. Please specify below 3. Recipient Information I authorize AHL to disclose my...
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