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*1ROI* REAUTHORIZATION FOR RELEASE OF INFORMATION Doc #5569 Revised 4/22/2021Page 1 of 1Patient Name: Date of birth: last four digits SS# (optional)Previous Last Name: I hereby authorize and request
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To fill out the date of birth last, follow these steps:
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Start by entering the day of your birth in the designated field. This is usually a numerical value between 1 and 31.
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What is date of birth last?
Date of birth last refers to the most recent date of birth.
Who is required to file date of birth last?
Anyone who needs to update their records with the most recent date of birth.
How to fill out date of birth last?
You can fill out the date of birth last by entering the correct date in the designated field.
What is the purpose of date of birth last?
The purpose of date of birth last is to ensure that records are up to date with the most recent information.
What information must be reported on date of birth last?
Only the most recent date of birth needs to be reported on date of birth last.
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