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UNIVERSITY Orthopedic ASSOCIATES, LLC AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION Patients Name: SSN: I hereby authorize the use and disclosure of individually identifiable
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University Orthopaedic Associates LLC is a medical practice specializing in orthopaedic care.
University Orthopaedic Associates LLC is required to file by its owners or members.
University Orthopaedic Associates LLC can be filled out by providing all required information about the business and its members.
The purpose of University Orthopaedic Associates LLC is to provide orthopaedic medical services to patients.
Information such as business name, address, members, and financial details must be reported on University Orthopaedic Associates LLC.
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