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Personal Information Patient Name: Date of Birth (D/M/Y): / / Mailing Address: Postal Code: Telephone (Home): (Work): (Cell): Email: Alberta Health Care #: Who may we thank for referring you to our
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Personal information - absolute refers to any data that can identify an individual, including but not limited to names, addresses, social security numbers, and other identifying details.
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Information that must be reported includes full name, address, date of birth, social security number, and any other identifying data specified by regulatory agencies.
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