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AUTHORIZATION FOR USE OR DISCLOSURE OF
PROTECTED HEALTH INFORMATION
Purpose of Disclosure: The reason I am authorizing release is:
Our Services
1 hr 30 min
120 US dollars
1 hr 30 min
120 US dollars
1 hr
120 US dollars
1 hr
120 US dollars
1 hr 30 min
120 US dollars
1 hr 30 min
50 US dollars
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