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BIRTH HOSPITALRELEASE OF INFORMATIONMedical Record #(Office Use Only)(Required items are in BOLD print Please do not use correction fluid or tape)Patient Name:Date of Birth: / / Previous Names: Address:

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What is address city state and?

Address, city, and state refer to the physical location of a person or business.

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Anyone who has a physical address, including individuals and businesses, may need to provide their address, city, and state information.

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You can fill out address, city, and state information on forms or online platforms where it is required.

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The purpose of providing address, city, and state information is to establish a person or business's physical location.

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The information that must be reported includes the street address, city, and state of the person or business.

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