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28 Park Ave, Williston, VT 05495 Phone (802)8781008 Fax (802)8722679 www.evergreenhealth.orgAUTHORIZATION TO DISCLOSE HEALTH INFORMATION I, Date of birth: (Name of patient whose information is being
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Formsevergreen family health is a form that collects information about an individual's family health history.
Individuals who are seeking medical advice or treatment may be required to file formsevergreen family health.
Formsevergreen family health can be filled out by providing accurate information about one's family health history in the designated fields on the form.
The purpose of formsevergreen family health is to help healthcare providers assess the risk of certain diseases based on an individual's family health history.
Information such as the medical history of immediate family members, any diagnosed illnesses, and lifestyle habits may need to be reported on formsevergreen family health.
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