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Get Illinois Eye Center Release Authorization Form

O the cancellation, and that action would not be considered a breach of confidentiality. I also acknowledge that: 1) recipients of this information may possibly re-release the information without proper authorization, and 2) once information is disclosed, it may no longer be protected by federal privacy regulations. I understand that I may review the disclosed information or ask questions by contacting the Privacy Officer at the above address. Illinois Eye Center does not require completion of t.

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