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Get Waiver Release And Assumption Of Risk Form

Expiration Date This authorization is valid for 1 year from date of signature or until specific date up to 2 years and covers records that were created or existing on or before the date this authorization was signed as well as records that are created after the date this authorization is signed up until the expiration date. 1309 R10/10/13 AUTHORIZATION FOR THE DISCLOSURE OF PROTECTED HEALTH INFORMATION Gundersen Lutheran Medical Center Inc. Gunde.

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