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1107 South Le may Avenue, Suite 140, Fort Collins, CO 80524 9702944464, Fax 9704821973Referral Form 1. Patients Name: Patient phone #: DOB: Primary language: Appointment date: Appointment time: Referring
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To fill out Obstetrix Medical Group of form, follow these steps:
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Obtain the form from the Obstetrix Medical Group office or website.
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Read the instructions carefully to understand the requirements and necessary information.
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Gather all relevant personal and medical information that needs to be included in the form.
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Start filling out the form by providing your personal details such as name, address, contact information, and date of birth.
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Fill in the required medical history information, including any previous pregnancies, medical conditions, medications, and allergies.
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Indicate your preferred Obstetrix Medical Group location or healthcare provider, if applicable.
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Review the completed form to ensure all information is accurate and complete.
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Sign and date the form as required.
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Submit the filled-out form to the Obstetrix Medical Group office by mail, fax, or in person.

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Obstetrix Medical Group is a group of healthcare professionals specializing in obstetrics and gynecology.
Obstetrix Medical Group is required to file by healthcare facilities and providers.
Obstetrix Medical Group should be filled out with accurate and detailed information regarding obstetrics and gynecology services.
The purpose of obstetrix medical group is to ensure proper reporting and documentation of obstetrics and gynecology services.
Information such as patient demographics, medical history, procedures performed, and outcomes must be reported on obstetrix medical group.
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