Privacy Consent AuthorizationSallyShareSallyShareSally ShareGLADYS ACHALEKE11507 GLOXINIA CTUPPER MARLBOROMD2077492187600 CARROLL AVETAKOMA PARKMD20912AYNALEMTENSAYEConsent Directive DetailsCONSENT FOR RELEASE OF SUBSTANCE
ABUSE INFORMATION I, Sally Shareauthorize to disclose to
all my medical information except the following
information: * Drug use information * Alcohol use and Alcoholism Information The purpose of this disclosure is all purpose:
Research, Healthcare Treatment, Restricted ConfidentialityRestricted ConfidentialityRestricted ConfidentialityRestricted ConfidentialityThis is a reference policy for sallysharemhc@gmail.com/*-
18718524001972570059RESEARCHTREATMENTsallysharemhc@gmail.comwrite2016-08-10T00:00:00-04002017-08-10T23:59:59-0400ETHALC