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KEVIN B. FITZGERALD, M.D. 1 FRANK H. ROLAND, JR., M.D. to furnish information to insurance carriers concerning my illness and treatments, and I hereby assign to the physician(s) all

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Page 1: KEVIN B. FITZGERALD, M.D. 1 FRANK H. ROLAND, JR., M.D. to furnish information to insurance carriers concerning my illness and treatments, and I hereby assign to the physician(s) all