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Get Texas Department Of Aging And Disability Services Form 0067 May 2005 Consent By Roommate For

, (name of resident) consent to the request of to conduct authorized electronic (name of resident or requestor) monitoring, in accordance with Chapters 242 and 247 of the Texas Health and Safety Code. I release from any civil liability for a violation of my/the resident s (circle one) (name of facility) privacy rights in connection with the use of the electronic monitoring device. Check all that apply below. NOTE: Implementation of restrictions with electronic monitoring is the responsibi.

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