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Anita Butler, C.CHT, BIBLE, BCE CONFIDENTIAL CLIENT INFORMATION AND HEALTH HISTORY First Name: M.I. Last Name: Address: City: State: Zip: Phone (h): (c): Birth Date: / / Email address Marital status:
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anitaampbutlerampcchtampba0ibclchbceamp confidentialampclient is a specific type of client whose information is considered confidential and must be handled with care.
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Individuals or entities who have access to anitaampbutlerampcchtampba0ibclchbceamp confidentialampclient information are required to file.
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anitaampbutlerampcchtampba0ibclchbceamp confidentialampclient may require reporting of personal or financial information of the client.
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