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c3-preview.prosites.comc3-preview.prosites.com/238431/wy/docs/Patient...With my consent, Dr. Bodenstein or his representative may mail to my home or other desianated location any items

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Page 1: c3-preview.prosites.comc3-preview.prosites.com/238431/wy/docs/Patient...With my consent, Dr. Bodenstein or his representative may mail to my home or other desianated location any items
Page 2: c3-preview.prosites.comc3-preview.prosites.com/238431/wy/docs/Patient...With my consent, Dr. Bodenstein or his representative may mail to my home or other desianated location any items
Page 3: c3-preview.prosites.comc3-preview.prosites.com/238431/wy/docs/Patient...With my consent, Dr. Bodenstein or his representative may mail to my home or other desianated location any items
Page 4: c3-preview.prosites.comc3-preview.prosites.com/238431/wy/docs/Patient...With my consent, Dr. Bodenstein or his representative may mail to my home or other desianated location any items
Page 5: c3-preview.prosites.comc3-preview.prosites.com/238431/wy/docs/Patient...With my consent, Dr. Bodenstein or his representative may mail to my home or other desianated location any items