DOC request three complete - Cannabis Defense Coalition

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I understand that I have a right to revo~e this authOrization at any time. I understand that if I revoke this
authorization I must do so in writing ~Ild present my written revocation to the Health Information Management
Department I understand Inat the revoca~on will not apply to infolTl'lation that has already been released in
response to this au orizati9n. Unless otherwise revoked, this authorization will expire on the following date, event, .
or condition: .' ,Q Ld