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Get and Sign the Giver Split Page Notes 13 16 Form
Person named below to
get the vaccine. I freely and voluntarily give my signed permission for the vaccines.
Privacy Notification: With few exceptions, you have the right
to request and be informed about information that the State of
Texas collects about you. You are entitled to receive and review
the information upon request. You also have the right to ask
the state agency to correct any information that is determined
to be incorrect. See http://www.dshs.tx.gov for more information on Privacy...
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