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CLINIC Patient Information Sheet ND 744 52 Street, 2 Fl. (PC), Oakland, CA 94609 pH: (510) 4283885 ext.2914, Fax: (510) 9952955 TIN # 940382330 NPI # 1003961251 Email: mail.CHO.org CHO MR # Date:
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Carefully read the instructions or prompts provided for each section to ensure you understand what information is required.
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Begin filling out the info sheet by entering your personal information, such as your full name, date of birth, and address. Be sure to double-check for spelling and accuracy.
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Move on to the contact information section and provide your phone number, email address, and any other contact details requested.
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Follow the instructions for each subsequent section, providing accurate and up-to-date information. This may include details about your work experience, including job titles, dates of employment, and a description of your responsibilities.
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Info sheet 2012doc is a document used to provide specific information about a certain topic or subject in the year 2012.
Any individual or organization that has relevant information to report is required to file info sheet 2012doc.
You can fill out info sheet 2012doc by providing accurate and complete information in the designated sections of the document.
The purpose of info sheet 2012doc is to gather and document important information for record keeping or analysis purposes.
The information that must be reported on info sheet 2012doc depends on the specific requirements of the document, but generally includes data, statistics, or other relevant details.
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