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AUTHORIZATION TO RELEASE HEALTHCARE INFORMATION Patient s Name: Date of Birth: Previous Name: Social Security #: I request and authorize: City: State: Zip: Phone: Fax: to release healthcare information
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What is mcmullen booth rd?
McMullen Booth Rd is a road located in Clearwater, Florida.
Who is required to file mcmullen booth rd?
Only businesses or individuals who have a business located on McMullen Booth Rd are required to file.
How to fill out mcmullen booth rd?
To file McMullen Booth Rd, you must provide information about your business, such as name, address, and type of business.
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The purpose of filing McMullen Booth Rd is to provide an accurate record of businesses on that road.
What information must be reported on mcmullen booth rd?
Information such as business name, address, phone number, and type of business must be reported on McMullen Booth Rd.
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