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Get CO Allergy & Asthma Centers Release Of Medical Information

E use/disclosure of health information about as described below: 1. Patient name and date of birth Persons(s) or class of persons authorized to use/disclose the information: name and address of disclosing party Person(s) or class of persons authorized to receive the information: Allen D. Adinoff, M.D. Jerald W. Ko.

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