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PROFESSIONAL RENEWAL CENTER Authorization to Release/Exchange Information Patient Name (please print) Other Names used in treatment, if Any Birth Date Last 4 digits of Social Security Number Address
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How to Fill Out Oformr Names Used In:

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Start by gathering all the necessary information about the individuals whose names will be used in the Oformr. This includes their full names, addresses, contact information, and any other relevant details.
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Oformr names are used to report the names that an individual or business uses for official purposes.
Individuals or businesses who have multiple names or aliases that they use for official purposes are required to file oformr names used in.
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The purpose of oformr names used in is to ensure that all names used by an individual or business are properly documented.
The information that must be reported on oformr names used in includes all the names that are used for official purposes.
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