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Patient Information Name Soc. Sec.×DateLocal AddressCityStateZipPermanent Address (if different)CityStateZipHome Phone Date of Birthed Phone Premarital Status (circle)Place of EmploymentMarriedOtherWork

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What is spouse or parent place?

Spouse or parent place is a section on a form where you provide information about your spouse or parent's place of residence.

Who is required to file spouse or parent place?

Individuals who have a spouse or parent and are required to provide information about their residence.

How to fill out spouse or parent place?

You can fill out the spouse or parent place section by providing the full address of your spouse or parent's place of residence.

What is the purpose of spouse or parent place?

The purpose of spouse or parent place is to ensure accurate and up-to-date information about the residence of an individual's spouse or parent.

What information must be reported on spouse or parent place?

You must report the full address, including street address, city, state, and zip code, of your spouse or parent's place of residence.

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