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Carmen Roman, M.D. 611 Veterans Boulevard, Suite 217 Redwood City, CA 94063 Fax: (650) 2602953Client Information All information is held in strict confidence. Please complete this form in black ink,
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Carmen Roman MD 611 is a specific form used for reporting certain medical-related information, typically associated with compliance or regulatory requirements.
Individuals or entities involved in medical practice or healthcare services that meet specific criteria as outlined by regulatory agencies are required to file Carmen Roman MD 611.
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The purpose of Carmen Roman MD 611 is to collect mandatory information to ensure compliance with healthcare regulations and facilitate tracking and reporting of medical services.
Information that must be reported includes provider details, patient information, services rendered, and any other specified data required by the regulatory authorities.
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