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600 N. Washington Council Grove, KS 668466207676811 6207675611 (fax) www.mrcohosp.comAUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATIONPatients name Date of Birth Social Security# (Last 4 digits):
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The 620-767-5611 fax refers to a specific form or document that needs to be submitted via fax for regulatory or compliance purposes, often related to tax or financial reporting.
Individuals or entities that meet specific criteria set by the regulatory authority and are required to report particular information related to taxes or financial data must file the 620-767-5611 fax.
To fill out the 620-767-5611 fax, ensure you have all relevant information and supporting documents, follow the provided instructions carefully, and enter the required data accurately on the form before sending it via fax.
The purpose of the 620-767-5611 fax is to collect essential information for regulatory compliance, enabling the authorities to monitor and verify the accuracy of reported data.
The information that must be reported on the 620-767-5611 fax typically includes details about income, deductions, beneficiaries, and any other relevant financial data as required by the governing body.
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