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Get and Sign Authorization for Request or Release of Medical CSU, Chico  Form

Get and Sign Authorization for Request or Release of Medical CSU, Chico Form

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Answered yes to any of the above please explain and note reaction Do you have any dietary restrictions vegetarian etc. If yes please explain PLEASE NOTE Information on this form will be referred to ONLY in case of a critical injury or emergency situation. In the instance that you are unable to provide medical information to an attending physician or hospital we would be able to provide it for you with your consent by signing below....
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