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Get Greenleaf Orthopaedic Associates, S.C. - Greenleafortho .com

Ing family members or third party persons, when necessary, to facilitate my care and well being, and/or the processing of my claim. I understand that I may revoke this consent at any time by giving written notice of my desire to do so to the physician. I understand that I will not be able to do so when the physician has already relied on it to use or disclose my health information. Written revocation of consent must be sent to the physician's office. Name Relationship Name Relationship Name.

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