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Megan Lewis, M.S., LEFT 7403 E. 6th Avenue Suite 5 Scottsdale, AZ 85251 Authorization to use/disclose informational of client (to use/share information about): Birthdate: Information From: Name/Address/Telephone
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Megan Lewis M is a form used for reporting certain information to the relevant authorities.
Any individual or entity required by law or regulations to report the specific information outlined in the form.
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