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FOR OFFICE USE ONLY Group:PLEASE PRINT ALL ANSWERSDate:Health Information Former Revised 5/18Please read and complete the entire form, front and back, carefully. You must complete and sign both this

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All answers refer to the complete set of responses required in a legal or formal document, typically in response to interrogatories or inquiries made during a legal proceeding.

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The parties involved in a legal case or any entity that has received a request for information or clarification is required to file all answers.

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The purpose of all answers is to provide necessary information, clarify legal positions, and ensure transparency during legal proceedings.

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All answers must report factual information pertinent to the questions posed, including relevant documents and evidence as required by the governing rules.

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