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AuthorizationforEmergencyMedicalTreatmentIntheeventemergencymedicalaid/treatmentisrequiredduetoillnessorinjuryduringtheprocessof receiving services, orwhilebeingontheproperty, IauthorizeCentaurStridestaffto:
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How to fill out familyphysiciannamephone
01
Find the section in the form that asks for your family physician's name and phone number.
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Write the name of your family physician in the designated space. Make sure to write it legibly and accurately.
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Provide the phone number of your family physician in the appropriate field. Double-check that the number is correct.
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Review the form before submitting to ensure that you have correctly filled out the family physician's name and phone number.
Who needs familyphysiciannamephone?
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Anyone filling out a form that requires information about their family physician will need to provide their family physician's name and phone number.
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This could include patients, individuals applying for medical services, or individuals providing information for insurance purposes.
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