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EFTA00283626
DENY CONSENT to ALL employee≤, agents and members of the medical staff of Mount Sinai to imeess.ANY. of my electordc health information through • HEALTKM for any purpose, &van In a atalcal emergency. NOTE: UNLESS YOU CHECKTHE'l MN CONSENT' BOX, New York State law allows hearth care - provitt-e.--s he
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