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Dr: Phone: Address: City: Patient: Zip: Sex: (by 5:00 PM) Pt Apt. Date: Time: Please send: INSTRUCTIONS: State: Age: Case Due: Enclosed: OTTAWA DENTAL LABORATORY Rx's Train Boxes Die Trim Fee Schedule
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The odl rx bformb download requires reporting information such as prescription medication details, patient information, prescriber details, pharmacy information, and other relevant data.
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