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Of NALFPC. I understand that I have the right to request a restriction as to how my protected health information is used or disclosed to carry out treatment, payment, or healthcare operations of the practice. NALFPC is not required to agree to the restrictions that I may request. However, if NALFPC agrees to a restriction that I request, the restriction is binding. I have the right to revoke this consent, in writing, at any time, except to the extent that NALFPC has taken action in reliance on.

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