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Indianapolis Vision Care · Patient Name Patient Address Patient Phone Number In the course of...

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Page 1: Indianapolis Vision Care · Patient Name Patient Address Patient Phone Number In the course of providing service to you, we create, receive, and store health information that identifies

Page 2: Indianapolis Vision Care · Patient Name Patient Address Patient Phone Number In the course of providing service to you, we create, receive, and store health information that identifies

Page 3: Indianapolis Vision Care · Patient Name Patient Address Patient Phone Number In the course of providing service to you, we create, receive, and store health information that identifies

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