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Piedmont Carolina Vascular Surgery s Notice of Privacy Practices provides a more complete description of such uses and disclosures. By signing this form I am consenting to Piedmont Carolina Vascular Surgery s use and disclosure of my PHI to carry out TPO. Of f ic e Us e We ig h t Martin V. Taormina MD Jennifer Gainer PA-C Pu ls e Medical Information Re s p Please answer all questions to the best of your knowledge. Out of State Insurance If the patient presents with an out of state HMO/PPO...
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