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Followup Site Questionnaire (PFU02) Participant ID: Protocol type: Phone/unperson interview 1 Enter PIP # here: Online survey2 Enter Web # here: Initials of person completing form: Date Form Completed:
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What is name of physician providing?
The name of the physician providing care.
Who is required to file name of physician providing?
Healthcare providers or facilities are required to file the name of physician providing.
How to fill out name of physician providing?
The name of the physician providing care should be filled out on the designated form or document.
What is the purpose of name of physician providing?
The purpose of providing the name of physician is to accurately document the healthcare provided.
What information must be reported on name of physician providing?
The name of the physician providing care must be reported.
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