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ATTACHMENT B Effective 12/1/2008 revised 6/09STATE OF NEBRASKAESTHETICIAN APPLICATION BY RECIPROCITYDEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health Licensure Unit P.O. Box 94986
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Request and consent is a formal process that allows an individual or entity to obtain permission from another party to carry out a specific action, such as sharing information or performing an activity that could affect them.
Individuals or entities seeking to obtain permission for certain actions that require legal authorization or consent from another party are required to file request and consent.
To fill out a request and consent, complete the provided form with accurate information regarding the action intended, provide the necessary details about the parties involved, and ensure all signatures are obtained where required.
The purpose of request and consent is to ensure that all parties involved are informed and agree to the actions being proposed, thereby protecting their rights and interests.
The request and consent must report information such as the names and details of the parties involved, the specific action being requested, any relevant dates, and the reasons for the request.
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