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NEW PATIENT REGISTRATION PATIENTS INFORMATIONPATIENT I.D. #Date: Name: FIRSTMIDDLELASTDate of Birth: / / Age (yrs mos): Gender: M / F Height: Weight: lbs Patient Address: STREETCITYSTATEZIPHome Phone
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Form IF is used to report on income and expenses from farming activities.
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Information such as income from sales of livestock, produce, and other products, as well as expenses such as feed, seed, and equipment costs must be reported on Form IF.
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