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GS RMC PHP REFERRAL FORM Referral Source Name: Agency: Phone: Date of Referral:Current Medications Include medications, dose & frequencyClient Information Name: MAN: DOB: Address: City, State, Zip:

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What is alan griffin do samaritan?

Alan Griffin do Samaritan is a financial disclosure form that certain individuals involved in Samaritan activities are required to fill out.

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Any individual who is involved in Samaritan activities and meets the criteria set forth by the Samaritan organization.

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The form can usually be filled out online or physically by providing the required financial information and submitting it to the appropriate authorities.

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The purpose of the form is to ensure transparency and accountability in Samaritan activities by disclosing any potential financial conflicts of interest.

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Typically, individuals are required to report their sources of income, assets, liabilities, and any financial relationships that may affect their involvement in Samaritan activities.

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