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Name of client:Other possible names:Date of birth:Phone #:Email address:Address:City:State:Zip:I hereby authorize St. Vincent Family Center to disclose or obtain my protected health information as
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The term 'oformr possible names' appears to be a typographical error or miscommunication. It may refer to official forms related to business names or entity registrations.
Typically, businesses or individuals looking to operate under a specific name that differs from their legal name are required to file the associated forms.
To fill out the form, provide the proposed business name, the legal name of the individual or entity, contact information, and any necessary supporting documents as specified by relevant authorities.
The purpose of filing such forms is to ensure legal recognition of the business name and to protect the rights of the business owner regarding the use of that name.
Required information typically includes the proposed name, the applicant's legal name, the type of business entity, business address, and potentially additional identification information.
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