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Stead Willis, III, DMD, PA 1212 Broad St. Durham, NC 27705 (919) 2862235 (919) 2862237 (fax) CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION Section A: Patient Giving Consent: Name: Phone #:
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Start by entering the date at the top of the form.
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What is stead willis iii dmd?
Stead Willis III DMD refers to a specific form or document related to dental practice or dental medicine, typically used for reporting purposes.
Who is required to file stead willis iii dmd?
Dental professionals, specifically those operating under certain regulations or jurisdictions that mandate the filing of this document, are required to file Stead Willis III DMD.
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To fill out Stead Willis III DMD, dental professionals should gather necessary personal and business information, ensure all sections are completed accurately, and follow any specific guidelines provided by the governing body.
What is the purpose of stead willis iii dmd?
The purpose of Stead Willis III DMD is to maintain regulatory compliance and to report specific data about dental practices, contributing to oversight and monitoring in the field.
What information must be reported on stead willis iii dmd?
Information required typically includes practice details, financial data, patient statistics, and compliance with health regulations.
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