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PATIENT INFORMATION First Name: EMAIL ADDRESS: Last Name: Middle Initial: Address: Birth date: Date: City: / Home Phone: (/) Age: Former Patient State: Male Female Alternative Phone (Cell, Pager):
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What is email address?
An email address is a unique identifier for an individual or organization used to send and receive electronic messages.
Who is required to file email address?
Any individual or organization who wishes to communicate electronically or receive electronic notifications is required to have a valid email address.
How to fill out email address?
To fill out an email address, you simply need to enter the desired address in the appropriate field, followed by the domain name and extension.
What is the purpose of email address?
The purpose of an email address is to facilitate electronic communication and the exchange of information between individuals and organizations.
What information must be reported on email address?
The only information required for an email address is the unique address itself, along with the domain name and extension.
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