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Auburn Memorial Medical Services, P.C. DBA Auburn Regional Diabetes and Endocrinology Authorization for Release of Protected Health Information To: Auburn Regional Diabetes and Endocrinology 77 Nelson
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How to fill out DBA Auburn Regional Diabetes:

01
Visit the official website of Auburn Regional Diabetes and locate the DBA form.
02
Begin by filling out your personal information such as your full name, contact details, and address.
03
Provide details about your business, including the name of your diabetes clinic or services, and the address where it operates.
04
Specify the nature of your business, whether it is a medical clinic, diabetes research facility, or any other relevant category.
05
Indicate the type of ownership, whether it is a sole proprietorship, partnership, or corporation.
06
If you are operating under a different name than your own, enter the Doing Business As (DBA) name that you will use for your diabetes-related services.
07
If applicable, provide information about any licenses or certifications that are required for diabetes clinics in your jurisdiction.
08
Sign and date the form to certify the accuracy of the information provided.

Who needs DBA Auburn Regional Diabetes:

01
Individuals or groups planning to start a diabetes clinic or offer diabetes-related services in the Auburn Regional area.
02
Healthcare professionals specializing in diabetes who want to establish their practice under a different name.
03
Existing healthcare clinics or organizations expanding their services to include diabetes treatment and management.
04
Researchers or medical professionals conducting diabetes studies or clinical trials in the Auburn Regional area.
05
Healthcare entrepreneurs looking to create partnerships or collaborations with the Auburn Regional Diabetes network.
Remember, it is always recommended to consult the official guidelines provided by Auburn Regional Diabetes or seek legal advice to ensure accurate completion of the DBA form.
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dba Auburn Regional Diabetes is a fictitious name used by a healthcare facility located in Auburn.
The owner or operator of the healthcare facility is required to file the fictitious name.
The form for filing a fictitious name can be obtained from the local government office and needs to be filled out with the required information.
The purpose of using a fictitious name is to conduct business under a name that is different from the legal entity's official name.
The filing may require information such as the legal name of the entity, the fictitious name being used, and contact information.
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