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PATIENT REGISTRATION Last Name First Name MI Address City/State Zip Home Phone Cell Phone Work Phone Physician you normally see Physician who referred you Date of Birth / / Sex: M F Marital Status
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How to fill out address citystate zip

How to fill out address citystate zip
01
To fill out the address, city, state, and zip code, follow these steps:
02
Start with the recipient's name and address at the top left corner of the envelope or form.
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Write the street address on the second line, providing any apartment or suite number if applicable.
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On the third line, write the city name, followed by a comma.
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After the comma, write the two-letter abbreviation for the state, such as CA for California.
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Add a single space after the state abbreviation and write the zip code, which consists of five numbers.
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Make sure to use a hyphen for zip codes that contain a plus-four extension, such as 12345-6789.
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Double-check the address, city, state, and zip code for accuracy before mailing or submitting the form.
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Address, city, state, and zip code are required by various entities and individuals who need to send or receive mail or documents. Some examples of who needs this information include:
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