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Webmay need to specifically consent, and, to the extent required by my state’s law, by signing below, I hereby do consent to the applicable Provider reporting my vaccination information to the Government Agencies, State HIE, or through the State HIE and/or State Registry to the entities and for the purposes described in this Informed Consent form. WebCH-23 Authorization for Release/Acquisition of Patient Information (Spanish) Clinic Health: CH-23 Instructions: Clinic Health: CH-45 Patient Encounter Form (Excel) Clinic Health: CH-45 Patient Encounter Form (PDF) Clinic Health: LHD COVID-19 Vaccination Supplemental PEF: Clinic Health: LHD COVID-19 Vaccination Supplemental PEF (Spanish) Clinic ... csudh music classes
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