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ApplicationReceivedat:2021 Sliding Fee Discount (Clinic)APPLICATIONLastNameFirstNameMailingAddressCityPrimaryPhoneDateofService StateZip20Morethan oneraceOtherPacific IslanderBlack/African Amer.AsianHispanic/
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Form community health nets is a reporting tool used to collect information on community health programs.
Healthcare organizations and community health programs are required to file form community health nets.
Form community health nets can be filled out online or submitted through a designated portal.
The purpose of form community health nets is to track and monitor the effectiveness of community health programs.
Information such as program goals, activities, outcomes, and funding sources must be reported on form community health nets.
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