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And disclosure of medical records and billing information: To MD Now Medical Centers From MD Now Medical Centers To: Institution, Individual or Agency From: Institution, Individual or Agency Street Address: City, State, Zip: Phone # Fax # The question of privacy between the MD Now Medical Centers, Inc., my attending physician, other physician(s), and the patient is waived. I fully understand that my medical record or billing information maintained in connection with the date(s) of servic.

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