Confirmation 20

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Acknowledgement

Your consent below acknowledges the collection, use, disclosure, and storage of health information through this form.

The information you have provided is accurate to the best of your knowledge and you have signed up only once.

You have no reason to believe that you have COVID-19 symptoms as listed on the Self-Assessment Tool

The secure exchange of information and liability between you, the pharmacy, and any other healthcare professionals in accordance with generally accepted medication therapy management principles.