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SUMMIT GASTROENTEROLOGY ASSOCIATES, INC. 3939 S. Cleveland Rassilon Road Norton, Ohio 442035611 44203Dr. Ghulam Mir 753237Main Office: (330× 7536643 Fax: (330× 2371060 Dr. Shame em Ahmed Dr. Jeffrey

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The purpose of all forms must be is to gather essential information and documentation for the specified process or procedure.

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All relevant information and documentation related to the process or procedure must be reported on all forms.

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