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Irvine Internal Medical Group Authorization For Use And Disclosure Of Medical Information I. Address:II. Date of Birth:Patient Name: Phone Number: Record Location: I authorize the healthcare provider
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Irvine Internal Medical Group is a medical practice located in Irvine, California that provides internal medicine services.
Anyone associated with Irvine Internal Medical Group who has financial interests or ownership in the practice may be required to file relevant documents.
To fill out Irvine Internal Medical Group documents, individuals must provide accurate financial information and ownership details.
The purpose of Irvine Internal Medical Group is to provide quality internal medicine services to patients in the Irvine area.
Information such as financial interests, ownership details, and any other relevant financial information must be reported on Irvine Internal Medical Group documents.
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