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Please use Patient Provided Information (PPI) application to generate this form. Click here to access further instructions and details http://intranet.mayo.edu/charlie/micspatientprovidedinformationrst/ppiforms/Generalized

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What is please use patient provided?

Please use patient provided refers to using information or details provided by the patient themselves.

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Healthcare providers or medical professionals may be required to file please use patient provided forms.

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Information such as medical history, current medications, allergies, and any other relevant health information provided by the patient must be reported.

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