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IN ELECTRONIC MEDIA 14-REQUIRES PRIVACY ACT STATEMENT AR 340-21 Security. DD Form 2005- Privacy Act Statement Health Care Record PDF-Fillable. Of the Affordable Care Act but in fact his dad wasn't able to do so. Keep this document and any other insurance materials in a safe place. Forms ROTC Chadron State College.

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These records may be transferred to other Government authorities for legitimate law enforcement inquiries, Sand court found that since the restrictions were lifted but not formally ended they were capable of being repeated.

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