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PATIENT INFORMATION AND ACKNOWLEDGEMENT OF PRIVACY NOTICE RECEIPT 1. Patients Name LastFirstMI AddressStreet & Apt #City State Home Photocell Honester Phonemic Address: Age Birthdate / / Married Single
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The term 'married - single' refers to the tax filing status that applies to individuals who are married but choose to file their taxes separately as single individuals.
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When filing married - single, individuals must report their income, any deductions or credits they are eligible for, and their spouse's information if applicable.
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