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EMPLOYEE WELLNESS PROGRAM RELEASE, PRIVACY AUTHORIZATION AND CONFIDENTIALITY NOTICE1. I hereby authorize and give permission to City of North Little Rock staff as designated by the Mayor to use the
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Anyone who is required to provide information or complete a specific task as requested on the form needs to fill it out. This can include individuals, organizations, businesses, or anyone else who is directed to do so by the concerned authority or organization.

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Please list anyone that refers to providing a list of individuals or entities as requested.
Any individual or entity who is requested to do so by the appropriate authority.
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