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CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION DOMINIC DAM ICO, D.M.D., P.C. TO THE PATIENT PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY Purpose of Consent: By signing this form, you will
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Consent for use is a legal document that grants permission to an individual or entity to use a certain product or service.
The individual or entity who wishes to use a product or service must file consent for use.
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The purpose of consent for use is to ensure that the individual or entity has permission to use the product or service legally.
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