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BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information...

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Page 1: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 2: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 3: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 4: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 5: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 6: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 7: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 8: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 9: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 10: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 11: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 12: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 13: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 14: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 15: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 16: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 17: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 18: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 19: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 20: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

Page 21: BHS Out Patient-20170407131546...C] NO, Facility Directory OPT-OUT: I object to having information related to me included in the Facility Directory while I am receiving outpatient

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