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9605 57th Avenue Corona, New York 11368 Toll Free Phone: (844) 3076537 Toll Free Fax: (844) 9414111THIS IS NOT A SCRIPT OPHTHALMOLOGY ENROLLMENT FORM Ship To:PatientPhysicianDate Needed Byrd:(1) PATIENT
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It is a form for reporting ophthalmology related information.
Ophthalmologists and eye care professionals are required to file.
The form can be filled out online or in paper form with relevant information.
The purpose is to gather data on ophthalmology practices and patient care for analysis and improvement.
Information such as patient demographics, diagnoses, treatments, and outcomes must be reported.
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