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UNI V ERST Y OF V VIRGINIA A HE LTD SYSTEM PLACE LABEL HERE. IF LABEL NOT AVAILABLE, WRITE IN PT NAME & MR# UNIVERSITY OF VIRGINIA MEDICAL CENTER AMBULANCE SIGNATURE FORM Patient Name: Transport Date:

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1. Visit the University of Virginia Medical website.
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The University of Virginia Medical refers to the medical center associated with the University of Virginia, which provides healthcare services and medical education.

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