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Ache Dr. Gordon Dr. Huguet Dr. Jessee Dr. Rehnke Dr. Rossidis Dr. Tas Sleeve Gastrectomy Duodenal Switch Primary Care Physician and any other physician who may have referred you to us Name Address Phone I understand that physicians providing medical/surgical services are not agents or employees of the hospital but to the contrary are independent medical practitioners exercising independent medical judgment at facilities provided by the hospital. Patient Signature of Acknowledgement. Fax form...
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