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WELCOME Tavern Healthcare Clinic Confidential Patient Information (Rev 9/16/11) Date of Birth: Social Security Number: Last Name: First Name: MI: Street Address: City/State/Zip: Email Address: Home
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Begin by gathering all your personal information and identification documents such as your social security number, date of birth, and address.
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Welcome - avere healthcare is a mandatory form required to be filed by all individuals who have received healthcare benefits.
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The welcome - avere healthcare form requires individuals to report details of all healthcare benefits received including provider information, dates of service, and total cost.
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