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511 Oakw ood Blvd Suite 301 Round Rock TX 78681 P 512 244-3698 F 512 244-0214 12201 Renfert Way Suite 225 P 512 339-6626 F 512 425-3809 1301 West 38thStreet P 512 454-5721 F 512 454-2801 1305 W. 34th Street P 512 459-8082 F 512 458-5446 301 Seton Parkw ay Suite 407 P 512 931-1656 F 512 485-1050 6836 Bee Cave Road Bldg 3 Ste 150 P 512 375-2555. I will not request records/health information from the provider/office. PATIENT With my parent s consent I am entering a confidential physician...
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This is the form number for the tax form.
Individuals or entities who meet certain criteria set by the tax authorities.
The form must be completed following the instructions provided by the tax authorities.
The form is used to report specific information to the tax authorities.
Details about income, expenses, and other relevant financial information.
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