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RELEASE OF INFORMATION FORM I, ___* (name, please print) of:___ (location or address) ___ give my consent to:___(name)of:___ (location or address) ___ to speak on my behalf to:___(name)of___ (location

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{"i": "Placeholder for the specific form or document being referred to"}

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{"i": "List of individuals or entities mandated by law or regulation to submit the form or document"}

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{"i": "Instructions and guidelines on how to complete the form or document"}

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