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Name: Record #: Address: Telephone#: WHIPLASHASSOCIATED DISORDERS (WAD) Minimum data/Initial visit (FORM A) Completed by patient or with assistance Check the appropriate answer or write answers where
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To fill out a name record, follow these steps:
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Start by entering your first name in the designated field.
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Next, enter your middle name, if applicable.
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Then, provide your last name in the corresponding field.
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If you have any suffixes or prefixes, enter them as well.
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Ensure the spelling and order of your names are correct.
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Double-check for any spelling errors or typos.
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Finally, save or submit the name record as required.

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A name record is a formal document used to register an individual's or entity's assumed name, also known as a 'doing business as' (DBA) name.
Individuals or businesses that operate under a name different from their legal name are required to file a name record.
To fill out a name record, you typically need to provide the legal name of the entity or individual, the assumed name, the address, and other identifying information as required by your local jurisdiction.
The purpose of a name record is to provide public notice of the name under which an individual or business is conducting its operations, and to prevent confusion among consumers.
The information that must be reported on a name record generally includes the legal name of the registrant, the assumed name, the type of business entity, and the business address.
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