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CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION Section A: Patient Giving Consent Patient(s) Name: Address: Telephone: Email: Patient #: Social Security #: Section B: TO THE PATIENT PLEASE READ
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Small Smiles is a financial reporting form used by individuals or businesses to report small income levels.
Individuals or businesses with small income levels are required to file Small Smiles.
Small Smiles can be filled out by providing information on income, expenses, and any other relevant financial details.
The purpose of Small Smiles is to accurately report small income levels for tax or financial purposes.
Information regarding income, expenses, and any other relevant financial details must be reported on Small Smiles.
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