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MAMMOGRAPHY WORKSHEET (See Privacy Act Statement on Reverse Side.) ALTA/ Annual Screening: CCS Pick Breast Ultrasound: List Diagnostic: Mammogram, Annual Screening (MAC) PATIENT IDENTIFICATION Mammogram,
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MAMC Form 1671-x is a form used for reporting financial information.
Individuals and entities meeting certain criteria are required to file MAMC Form 1671-x.
MAMC Form 1671-x should be filled out by providing all required financial information accurately.
The purpose of MAMC Form 1671-x is to report financial information for regulatory compliance.
MAMC Form 1671-x requires reporting of income, expenses, assets, and liabilities.
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