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Get CA DS 326 2010

MEDICAL INFORMATION AUTHORIZATION MEDICAL PROFESSIONAL, HOSPITAL, OR MEDICAL FACILITY (NAME AND ADDRESS) DATE MEDICAL RECORD/PATIENT FILE NO. I hereby authorize my medical professional or hospital to answer any questions from the Department of Motor Vehicles, or its employees, relating to my physical or mental condition, and/or drug and/or alcohol use, and to release any related information or records to the Department of Motor Vehicles or its employees. Any expense involved is to be charge.

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