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Indianapolis (Marion County) Medical Society 631 East New York Street Indianapolis, IN 462023706 Telephone (317× 6393406 Fax (317× 2625609 Email: IMS online.org The mission of Indianapolis Medical

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1. Start by gathering all the necessary information required to fill out the form, such as personal details, medical history, and insurance information.
2. Carefully read through the instructions provided on the form to ensure that you understand each section and the information required.
3. Begin by providing your full name, address, contact information, and any other required personal details in the designated fields.
4. Move on to the medical history section, where you will be asked about any pre-existing conditions, ongoing medications, allergies, and past surgeries. Fill out this section accurately to provide the medical professionals with a comprehensive understanding of your health.
5. If necessary, provide details about your insurance coverage and policy information. This is important to ensure proper billing and reimbursement for medical services.
6. Review the completed form for any errors or missing information before submitting it. Double-check that all fields are filled correctly and completely.
7. Finally, sign and date the form to certify its accuracy and completeness.

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1. Individuals seeking medical care or treatment in Indianapolis, Indiana.
2. Patients visiting doctors, clinics, or hospitals in the Indianapolis area.
3. Any individual required to provide their medical information for administrative or legal purposes in Indianapolis.

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