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COUNTY HEALTH DEPARTMENTDISEASE REPORT FORM FOR PHYSICIANS AND OTHER HEALTH CARE PROVIDERS Case Information DATE: Reported by: Organization: Cases Name: Parents Name: Age: Date of Birth: Sex: () Male
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For physicians and oformr is a form that physicians are required to fill out to report certain information.
Physicians and other medical professionals are required to file for physicians and oformr.
Physicians can fill out for physicians and oformr online or by submitting a paper form.
The purpose of for physicians and oformr is to collect information about physicians and their financial relationships.
Physicians must report information such as payments received from pharmaceutical companies and medical equipment manufacturers.
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