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Get FL AHCA 1000-3003 2018

___________________ Legal Authority (If Other Than Individual): ________________________________________________ *If you are a legal representative of the person whose information you are requesting, you must provide documentation proving your legal authority to request this information (for example, power of attorney, guardianship papers, health care surrogate form, Custody Order, Order Appointing Personal Representative, Letters of Administration). AHCA Form 1000-3003, Revised (FEB 2018) Pag.

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