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UNIVERSITY OF SOUTHERN CALIFORNIA ACCEPTANCE OF REQUEST TO AMEND PROTECTED HEALTH INFORMATION Patient Name: Date of Birth: Phone Number: Address: Date of Amendment Request Form: Date of this Acceptance
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The University of Southern California (USC) is a private research university located in Los Angeles, California.
Any individual or organization that received income or engaged in transactions in California may be required to file the University of Southern California form.
To fill out the University of Southern California form, you will need to provide information about your income and transactions in California. The form may be filled out online or paper forms can be mailed.
The purpose of the University of Southern California form is to report income and transactions conducted in California for tax or regulatory purposes.
Information such as income earned in California, expenses incurred in California, and any transactions conducted within the state must be reported on the University of Southern California form.
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