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Special Authorization for Minors

Microsoft Word 97-2003 (.doc)
Authorization form to release information for minors.

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LAKEWOOD HEALTH SYSTEM

49725 County 83 Staples, MN 56479

Tel: 218-894-1515 | 800-525-1033 | TTY - 218-894-8184

Tel: 218-894-1515
| 800-525-1033
| TTY - 218-894-8184

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