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Date of Request Chart #Visit Number: Location:BASSETT HEALTHCARE NETWORK OBSTETRICS LAB REQUEST FORM #10×5835×5835 12/12/07,1/14/08,10/6/08,1/9/09,4/6/09,7/6/09,1/4/10,2/10/10 7/19/10,10/4/2010,1/3/11,4/4/11,
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To fill out the 5835 Bassett Healthcare Network form, follow these steps:
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Provide accurate and complete information for all the required fields.
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Submit the filled out form to Bassett Healthcare Network through the designated submission method mentioned in the instructions.

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5835 Bassett Healthcare Network is a form used by healthcare providers to report certain information related to healthcare services provided.
Healthcare providers such as hospitals, clinics, and medical practices are required to file 5835 Bassett Healthcare Network.
5835 Bassett Healthcare Network should be filled out with accurate and complete information regarding the healthcare services provided.
The purpose of 5835 Bassett Healthcare Network is to report information about healthcare services provided by healthcare providers.
Information such as patient demographics, diagnoses, procedures, and charges must be reported on 5835 Bassett Healthcare Network.
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