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LAVALIERE HEALTH Center 1348 PEMBROKE ST. W. PEMBROKE 613 635 7206 CHILD INTAKE FORM (212 year) Child's Name Date: Parents Names: Child's Date of Birth (M×D/Y) Sex M F Child's Address Email Address:
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How to fill out lavallee health centre 1348:
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What is lavallee health centre 1348?
The lavallee health centre 1348 is a form used for reporting health care services provided by the Lavallee Health Centre.
Who is required to file lavallee health centre 1348?
Health care providers and facilities that are associated with Lavallee Health Centre are required to file the form 1348.
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The lavallee health centre 1348 form can be filled out online or submitted in hard copy with the required information about the health care services provided.
What is the purpose of lavallee health centre 1348?
The purpose of lavallee health centre 1348 is to track and report health care services provided by the Lavallee Health Centre.
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Information such as patient demographics, services provided, dates of service, and billing information must be reported on lavallee health centre 1348.
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