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PATIENT INFORMATION RECORDABLE ROUNDEL DERMATOLOGY, P.A. Please PRINT All Information. PATIENT INFORMATIONAL SOCIAL SECURITY NUMBERPATIENT\'S NAME (LAST, FIRST, MI)STREET ADDRESSCITYHOME PHONESTATEWORK
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Have you ever been is a form used to disclose any past criminal history or legal issues.
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The purpose of have you ever been is to ensure transparency and honesty about any past legal issues that may impact eligibility for certain opportunities.
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