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INFORMED CONSENT DOCUMENT AGREEMENT TO BE IN A RESEARCH STUDY NAME OF SPONSOR COMPANY: Maggie Jeffries, MD PROTOCOL NUMBER AND TITLE OF STUDY:ANES001NAME OF PERSON IN CHARGE OF THE RESEARCH STUDY

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This is an important document that serves to report specific financial or legal information as required by regulations.

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Individuals or organizations that meet certain criteria set by regulatory authorities are required to file this document.

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