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Oregon Health Authority Capitol Project Reporting Form (CPR1) Reporting Entity Identification and Contact Facility Name: Federal Tax ID#: Address: City:Providence New berg Medical Center (PNC) 931146501 1001
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Start by gathering all the necessary information and documents needed to fill out the application.
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Visit the Providence Newberg Medical Center website and locate the 'Patient Forms' section.
03
Download and print out the necessary form(s) for the application.
04
Read the instructions carefully to understand the information required in each section of the form.
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Fill in your personal information, such as name, address, contact details, and date of birth.
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Provide details about your medical history, including any pre-existing conditions, allergies, medications, and previous treatments or surgeries.
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Sign and date the completed form(s) where necessary.
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Submit the filled-out form(s) to the Providence Newberg Medical Center either in person or through the designated submission method mentioned in the instructions.

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Providence Newberg Medical Center is a hospital located in Newberg, Oregon that provides medical services to the community.
The administration of Providence Newberg Medical Center is responsible for filing the necessary paperwork.
To fill out Providence Newberg Medical Center forms, the required information must be accurately entered, following the instructions provided by the hospital administration.
The purpose of Providence Newberg Medical Center is to provide quality healthcare services to patients in need.
Information such as patient demographics, medical history, treatments provided, and insurance details must be reported on Providence Newberg Medical Center forms.
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