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Proof of Pasco County Residency such as a Florida Driver s License or utility bill showing a Pasco County address with your name. 12/2016 Date Page 1 of 2 Patient Attestation/Authorization I hereby certify that all information provided by me on this application and financial disclosure is true and accurate. I certify that I live in Pasco County. All patients must be US citizens or legal permanent residents. GOOD SAMARITAN CLINIC of PASCO Inc. 5334 Aspen Street New Port Richey FL 34652 727...
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How to fill out good samaritan clinic of
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Step 1: Visit the Good Samaritan Clinic of website or physical location
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Step 2: Complete the patient registration form with accurate personal information
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Step 3: Provide any relevant medical history or documentation
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Step 4: Attend the scheduled clinic appointment
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Step 5: Follow the instructions from the healthcare professionals
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Step 6: Follow up if necessary and continue to receive care at the clinic as needed
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What is good samaritan clinic of?
Good Samaritan Clinic provides free medical care to people in need.
Who is required to file good samaritan clinic of?
Non-profit organizations and medical professionals running free clinics are required to file Good Samaritan Clinic forms.
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Good Samaritan Clinic forms can be filled out online through the designated government website.
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The purpose of Good Samaritan Clinic forms is to track the services provided by free medical clinics.
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Good Samaritan Clinic forms require information on the number of patients served, the types of medical services provided, and the value of donated services.
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