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Susan Ion Hogan, DDS, PA 27 Barkley Circle, Ft Myers, FL 33907 CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION SECTION A: PATIENT GIVING CONSENT Name: Address: Telephone: Email: Patient Number:
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What is susan ion hogan dds?
Susan Ion Hogan DDS is a dental practice owned by Dr. Susan Ion Hogan.
Who is required to file susan ion hogan dds?
Dr. Susan Ion Hogan or any authorized representative of the dental practice.
How to fill out susan ion hogan dds?
Susan Ion Hogan DDS form should be filled out with accurate and up-to-date information regarding the dental practice's financial status and operations.
What is the purpose of susan ion hogan dds?
The purpose of Susan Ion Hogan DDS form is to report the financial information and operational details of the dental practice.
What information must be reported on susan ion hogan dds?
The information to be reported on Susan Ion Hogan DDS form includes financial statements, patient statistics, and any changes in practice ownership.
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