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Nm2765CONSENT FORM12/13/91ENCLOSURE 160001011.10.1 0 G0001OI I. I CONSENT FORM '2765Uwe agree to permit explain natives of contractors of the U.S. Department of Energy (DOE)to enter upon my/our property
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This consent form is used for authorizing the release of medical information.
The individual requesting the release of medical information is required to file the consent form.
The form should be completed with the individual's personal information and signed to authorize the release of medical information.
The purpose of this form is to give permission for the release of medical information to specified parties.
The form should include details such as the individual's name, date of birth, specific information to be released, and the parties authorized to receive the information.
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