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Get and Sign Instructions to Completing the Authorization for Protected 2019-2022 Form

Get and Sign Instructions to Completing the Authorization for Protected 2019-2022 Form

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Dental Record Orthodontic treatment notes Including orthodontic-related photos and x-rays Periodontic Charting Treatment Progress/Visit Notes Billing/Financial Statements Other Please be specific MUSC College of Dental Medicine Florence All Treatment Dates Lancaster OTE 700078 Rev. 09/2019 Marion I understand this information may include reference to psychiatric / psychological care sexual assault drug abuse results of tests for all infectious diseases including HIV / AIDS and / or alcohol...
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