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SOUTHWEST SPORT & SPINE CENTER, INC. PATIENT INFORMATION PLEASE PRINT CLEARLY Today's Date: PATIENT INFORMATION (To be completed by patient or responsible party) Name: Mailing Address: Sex: M F Physical
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Southwest Sport & Spine is a medical facility specializing in sports medicine and spinal care.
Healthcare providers and medical facilities that provide sports medicine and spinal care services are required to file Southwest Sport & Spine forms.
Southwest Sport & Spine forms can be filled out electronically or manually by providing all relevant patient information and treatment details.
The purpose of Southwest Sport & Spine forms is to document and report patient care and treatment related to sports injuries and spinal conditions.
Southwest Sport & Spine forms must include patient demographics, treatment codes, diagnosis codes, and treatment notes.
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