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OHIO UNIVERSITY LANCASTERMEDICAL ASSISTING TECHNOLOGY PROGRAMHEALTH Formic any questions, please contact the MAT Program Director at 7406813708.PART ITO BE COMPLETED BY APPLICANT:Name___Phone___Address___Date of Birth___City, State___Zip Code___OU PID#___OF Email___I authorize the physician to release medical information as deemed necessary for my training.______Signature of StudentDatePART INTO BE COMPLETED BY PHYSICIAN OR HEALTH Department
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mat health formdocx is a document used for reporting health information of individuals.
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