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OFMHSFM035 Rev #2Rev. 04/19/2021 STATE HOSPITALTRIAGE CONSULTATION & EXPEDITED ADMISSION (TEA) REQUEST (Please type)Patients last name:Interpreter requiredFirst:Language:PATIENT INFORMATION Middle:Cause
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ofmhs-fm-035 rev 2 is a specific form used for reporting certain financial or operational data, typically required by a government or regulatory body.
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Information that must be reported typically includes financial data, organizational details, operational metrics, and any other relevant information specified by the overseeing body.
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