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CLIENT INFORMATION Patient Name: Street Address: City, State, Zip: Date of Birth:SSN:Gender:Marital Status: EmployedWork Status: Unemployed Full time Student Part time StudentEmployer/School & Address:
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Employerschool amp address is the address of the employer's school or educational institution where they are employed.
Employers are required to file their school or educational institution address as part of their employee information.
Employers can fill out the school or educational institution address by providing the name, address, and contact information of the school.
The purpose of employerschool amp address is to accurately identify the employer's place of work or educational institution.
Employers must report the name, address, and contact information of the school or educational institution where they are employed.
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