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New York State Sterilization Consent Form

New York State Sterilization Consent Form

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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 A. F*D*C* or Medicaid that I am now getting or for which I may become eligible. I UNDERSTAND THAT THE STERILIZATION MUST BE CONSIDERED PERMANENT AND NOT REVERSIBLE* I HAVE DECIDED THAT I DO NOT WANT TO BECOME PREGNANT BEAR...
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