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Consent to the Disclosure of Individually Identifying Health Information Statement of Benefits Paid PO Box 1360 Station Main Edmonton AB T5J 2N3235804871Law Firm/Insurance Company Unique Lifetime

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Your new customized consent is a tailored agreement that outlines the specific permissions and agreements related to the handling of your personal or sensitive information.

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The information that must be reported includes the identity of the data collector, the purpose of data collection, types of data collected, and the rights of the individual regarding their information.

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