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OB/GUN WOMEN Center OF LAKEWOOD RANCH, LLC PATIENT CONSENT FOR USE, DISCLOSURE OR REQUEST OF HEALTH INFORMATION FOR TREATMENT OR PAYMENT Patient Name: As part of your healthcare, this practice originates
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OBGYN Women's Centre offers a variety of services related to obstetrics, gynecology, and women's health.
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Information such as personal details, medical history, insurance information, and reason for visit may need to be reported on OBGYN Women's Centre forms.
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