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Notice of Privacy Practices
Weigel Family Eye Care, Optometrist, P.C.
223 E. Washington St., PO Box 167
Greensburg, IN 47240
812-663-2480
Fax: 812-662-0486
Office contact: Dr. Weigel
Effective date of notice: September 1, 2013
AUTHORIZATION FOR RELEASE OF IDENTIFYING HEALTH INFORMATION
I authorize the professional office of my optometrist named above to release health information about me to the following persons:
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