Authorization to Release Health Care Information From Wheatland Memorial Healthcare

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https://na4.documents.adobe.com/public/esignWidget?wid=CBFCIBAA3AAABLblqZhBGOY_PtMdHkaR2TghCsBM9GcE_X4Xdu2U2yELVdlaHiB9ABkz3b8Sqe8aSdIU_BLY*