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Connally & Kauffman DentistryConsent for Use and Disclosure of Health Information Section A: PATIENT GIVING CONSENT Name: Address: Email: ___Telephone: Social Security Number:Section B: TO THE PATIENTPLEASE
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The consent for use and is a form that allows individuals to give permission for their personal information to be used.
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The purpose of the consent for use form is to ensure that individuals are aware of how their personal information will be used and to obtain their explicit consent for its use.
The consent for use form typically requires individuals to provide their name, contact information, and a signature indicating their consent.
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