div class=ts-pagebutton class=gotoPage data-page=1Page 1button div class=ts-imageimg data-url=c1-ffeae-mme-name-h-over-1b-name-here-main-street-dental-consent-for-use-and-disclosurehtmlpage=1 data-page=1 class=ts-thumb lazyload alt=Page 1: c1-previewprositescomc1-previewprositescom86831wydocsimg009pdf · ffea$e Mme name h over 1B name here Main Street Dental CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader034vdocumentsusreader034viewer20220520006011c402c62d7b61135a5efbhtml5thumbnails1jpg width=140 height=200 divdiv