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Providence Medical Group New berg Primary Care Provider Medical History Patient Name: Date: LastFirstMiddlePreferred Name: DOB: Age: Sex: Male Female MonthDayYearLast Doctor/Clinic: Who referred you
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Providence Medical Group Newberg is a healthcare provider group located in Newberg, Oregon.
Healthcare providers affiliated with Providence Medical Group Newberg are required to file.
You can fill out Providence Medical Group Newberg by providing all requested information accurately and completely.
The purpose of Providence Medical Group Newberg is to collect and report healthcare data for analysis and improvement.
Information such as patient demographics, medical history, treatments, and outcomes must be reported on Providence Medical Group Newberg.
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