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Revocation of Authorization to Disclose Health Information I WANT TO CANCEL, OR REVOKE, THE PERMISSION I GAVE TO ILLINICARE HEALTH TO SHARE MY HEALTH INFORMATION WITH THIS PERSON OR GROUP:MAIL TO: Illogical
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I want to cancel refers to the action of revoking or voiding a previous request or agreement.
Anyone who wishes to revoke a request or agreement may be required to file an 'I want to cancel' form.
To fill out an 'I want to cancel' form, one must provide their personal details, the request or agreement they wish to cancel, and the reason for cancellation.
The purpose of 'I want to cancel' is to formally revoke or void a previous request or agreement.
The 'I want to cancel' form may require personal details, details of the request or agreement being canceled, and the reason for cancellation.
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