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()Fax completed form to: (855) 8401678 If this is an URGENT request, please call (800) 8824462 (800.88.CHINA)PHYSICIAN INFORMATIONPATIENT INFORMATION* Physician Name: Specialty:*Due to privacy regulations
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Seriously jeopardize form customers is a form that is used to report incidents where a customer's security and financial information may have been compromised.
Any entity that stores or processes customer information and experiences a data breach that may seriously jeopardize customers is required to file this form.
The form typically requires detailed information about the data breach, including when it occurred, the type of information compromised, and steps taken to mitigate the breach.
The purpose of the form is to ensure transparency and accountability in the event of a data breach that seriously jeopardizes customers.
The form typically requires information about the breach, the number of customers affected, the type of information compromised, and the steps taken to address the breach.
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