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Health Partners of Western Ohio School Parental Consent Form STUDENT INFORMATION Students Last Name: Students First Name: Date of Birth: Students Social Security Number: Sex: Male Female Grade: Ethnicity:
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Health Partners of Western is a health organization aimed at providing healthcare services to the western region.
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The purpose of Health Partners of Western is to collect data on healthcare services in the western region to improve healthcare delivery and accessibility.
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Information such as number of patients served, types of healthcare services provided, and demographic data of patients must be reported on Health Partners of Western.
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