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Eatment and my health plan will not condition payment, enrollment, or eligibility on my signing this designation. 5. I understand that I may revoke this designation of personal representative at any time by sending a written notification to the Privacy Office at the address listed below, and this revocation will be effective for future uses and disclosures of protected health information. . However, I further understand that this revocation will not be effective for information that my health pl.

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