Revoke Individual Access to MyHealthRecord

Revoke Individual Access to MyHealthRecord
By signing below, I give Allegro Pediatrics permission to revoke access to MyHealthRecord from all individual(s) listed on my account other than myself. The individual(s) I previously gave access to will no longer be able to obtain my health care information or act on my behalf to make healthcare decisions. This includes but is not limited to accessing my medical records and discussing my healthcare with any Allegro staff or provider.
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