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Mylar Adult Proxy Authorization Form 1900 South Avenue, FBB-001, La Crosse, WI 54601 PHONE: (800) 362-9567, Ext. 53199 or (608) 775-3199 FAX: (608) 775-4706 Patient Name: Patient Address: City/State/Zip:
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Gundluth is a term used to refer to a specific financial document or form.
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