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Dr Frank Coal, MD Workers Comp Name of Referral Source: Tel: Address: Reason for Referral: Patient Information Last Name Birth date: First Name Age Sex M Middle Initial SS#: Mr Mrs. Miss Ms. F Date
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What is dr frank coufal md?
Dr. Frank Coufal MD is a medical doctor.
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Medical professionals who are licensed to practice and provide medical care.
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Information such as patient's name, date of birth, medical conditions, medications, and treatment plans must be reported on dr. Frank Coufal MD form.
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