Chronic Disease Management Details

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History of Diagnosis: Type of Chronic Illness
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I hereby give my explicit consent for MAKL to share my personal information with other service providers in connection with my care. This includes the accessing and sharing of my medical records, and if applicable, mental health and registration documents.

I acknowledge and agree that MAKL is authorized to make referrals to other appropriate service providers as deemed necessary to support my needs. I understand the implications of this consent and authorize the sharing of the mentioned information for the purposes of my care and well-being.
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