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Get NY Main Street Radiology Permission For Operative And/or Diagnostic Procedure And/or Treatment And 2019-2024

(Insert Physician or if appropriate, Health Care Practitioner Name, if name of Radiologist is unknown insert name of Chairman and associates or assistants of his/her choice at the New York Hospital Medical Center of Queens Medical Center ) and its physician practice subsidiaries to perform upon me or the named patient, the following operations, procedures, and/or sedation:.

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