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TEXAS HEALTH CARE, P.L.L.C.PHYSICIAN: P.O. Box 961205 Fort Worth, Texas 761611205BEING SEEN TODAYLOCATION: DATE: PATIENT REGISTRATION INFORMATION If Patient cannot be billed for these services (for

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What is box 961205?

Box 961205 is a section on a specific form used for reporting certain information to the relevant authorities.

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Entities or individuals specified by the relevant authorities are required to file box 961205.

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Box 961205 should be filled out according to the instructions provided by the relevant authorities.

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The purpose of box 961205 is to gather specific information for regulatory or compliance purposes.

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Information required to be reported on box 961205 may include financial data, transaction details, or other relevant information as specified by the authorities.

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