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If your insurance company requires a referral, it is your responsibility to obtain it prior to your appointment. PDF processed with Cute PDF evaluation edition WWW.
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If the question or statement in the "yes no date of" section is a closed-ended question that requires a simple yes or no response, select the appropriate option.
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If the question or statement in the "yes no date of" section is asking for a date, enter the relevant date using the specified format (e.g., month/day/year or day/month/year).
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Yes No Date of refers to indicating whether a date is applicable or not.
Anyone who needs to provide information about a specific date is required to fill out Yes No Date of.
To fill out Yes No Date of, simply indicate whether the date in question is applicable or not by selecting 'Yes' or 'No'.
The purpose of Yes No Date of is to clarify whether a specific date is relevant to the situation at hand.
Only the relevance of a specific date needs to be reported on Yes No Date of.
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