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Get Johns Hopkins Rheumatology Authorization for Release of Health Information 2008-2024

Understand that: • • • • • • This authorization is voluntary. My treatment will not be impacted, no matter if I sign this authorization or not. If I do not sign this authorization, Johns Hopkins will not disclose My Health Information as requested. I will receive a copy of this authorization upon signature. This authorization is valid for one year from date signed, unless I revoke this authorization or unless an earlier date is specified here: _______________. I may revoke this aut.

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