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    And to include any federal and state protected under Florida statute 3 94.459(9) Psychiatric information, Florida Statute 397.501 and Florida Statute 397.112 Drug and /or Alcohol Abuse information and Florida Statute 381.004 and FAC 10D-39.064 Human Immunodeficiency Virus test results ( HIV testing, AIDS and related conditions).












    When you submit, your form will be sent to a HIPAA secure account.