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Rest M. Rank, M.D. Daniel F. Miller, M.D. Robert H. South, M.D. 415 N. Causeway NSB, FL 32169 (386) 4274143 Patient Name: DOB: Name of parents/guardians if under 18: Social Security #: Mailing address:
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Begin filling out the form by providing your personal information accurately. This may include your full name, date of birth, contact information, and social security number.
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Orest M is a form used for reporting certain financial transactions.
Individuals or entities involved in the specific financial transactions outlined in the form.
The form can be filled out online or by paper, following the instructions provided by the relevant authority.
The purpose of the form is to track and monitor certain financial transactions for regulatory and compliance purposes.
Information such as the nature of the transaction, the parties involved, and the amount of money exchanged.
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