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Robert W. Heidepriem III M. D. F.A. C. S. Professional Office Building 2018 Brookwood Medical Center Drive Suite 214 Birmingham Alabama 35209 Phone 205-423-2495 Fax 205-423-2498 www. Birminghamvascularassociatespc.com PATIENT MEDICAL HISTORY FORM Name Date Social Security DOB Height Weight Email Primary Care Physician Referred by Pharmacy Name/Location/Phone Number Dialysis Center and Phone Number if applicable Do you have a Pacemaker Y NDefibrillator Y NCardiac Stents Y N Name and Phone...
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What is heidepriem iii m?
Heidepriem III M is a financial disclosure form that may be required to be filed by certain individuals.
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Certain individuals, such as public officials or employees, may be required to file Heidepriem III M.
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The purpose of Heidepriem III M is to provide transparency and accountability regarding the financial interests of certain individuals.
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Heidepriem III M typically requires the reporting of financial assets, income sources, liabilities, and other relevant financial information.
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