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Today's Date / / PATIENT INFORMATION Patient Name Outpatient REGISTRATION FORM Firsts this your legal name? Middle MRI not, what is your legal name? YES NO Street or Mailing Address (circle one)Mitchell
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Street or mailing address is the specific location where mail can be delivered to an individual or organization.
Anyone who wishes to receive mail or packages at a specific location is required to file a street or mailing address.
To fill out a street or mailing address, one must provide the necessary information such as street name, house/ building number, city, state, and zip code.
The purpose of street or mailing address is to ensure that mail or packages reach the intended recipient at the correct location.
The information that must be reported on street or mailing address includes the recipient's name, street name, house/ building number, city, state, and zip code.
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