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Print Form State of New Hampshire Department of Health and Human Services Bureau of Elderly and Adult Services BEAS 4/11 BEAS STATE REGISTRY CONSENT FORM RSA 161-F 49 Employer Information For Official Use Only I hereby authorize the release of any adult abuse neglect and/or exploitation record that you may find concerning me to This portion must be filled out in order to be processed. Employer Name Mailing Address City/State/Zip Telephone Fax PLE.

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