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PATIENT INFORMATIONINSURANCEDateWho is responsible for this account? NameRelationship to Patient AddressInsurance Co. CityStateSex: M F Single Married Birthdate Significant Other Widowed Separated
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Significant oformr is a form used to disclose significant financial interests or relationships.
Individuals who hold significant financial interests or relationships are required to file significant oformr.
To fill out significant oformr, individuals need to provide detailed information about their financial interests or relationships.
The purpose of significant oformr is to promote transparency and prevent conflicts of interest.
Information such as financial investments, ownership interests, and partnerships must be reported on significant oformr.
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