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En fantasia Dumb Tl. 72 48 04 enfantasiadumbea@mdf.nc www.mdf.ncFORMULAIRE DE REASSIGNMENTS MEDIC AUX No met prom DE Enfant ___ Not Du Devin trait ant :___ Tl phone :___VACCINATIONS Merci de nous
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docenf002-05 v2 renseignements medicauxautorisation is a medical information authorization form.
Individuals who are seeking medical treatment or services.
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The purpose is to authorize the release of medical information to healthcare providers or insurance companies.
Personal information, medical history, current medications, and any relevant health conditions.
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