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Get and Sign Consent for Sterilization in Kentucky 2014-2022 Form
For and received information about sterilization from __________________________________ (doctor or clinic). When I first asked for the information, I was told that the
decision to be sterilized is completely up to me. I was told that I could decide not to be sterilized. If I decide not to be sterilized, my decision will not affect my right to future care or treatment.
I will not lose any help or benefits from programs receiving Federal funds, such as Temporary Assistance for Needy Families...
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