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Hearing Screen Reporting Form fax completed form to 701.858.3483 Please enter contact information of the PERSON FILLING OUT FORM Name: Agency: Phone: Email: Patient Information Child's name (Last,
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What is fax completed form to?
The completed form should be faxed to the designated fax number.
Who is required to file fax completed form to?
All relevant parties or individuals are required to file the completed form.
How to fill out fax completed form to?
The form should be filled out completely and accurately before faxing it to the designated number.
What is the purpose of fax completed form to?
The purpose of faxing the completed form is to submit necessary information or documentation.
What information must be reported on fax completed form to?
The completed form must contain all required information as specified in the form instructions.
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