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Solicited de Audi financier Patient×Guarantor Information Hombre Del patients: ___ Hombre Del gar ante (is El patients BS minor DE 18 AOS): ___ Direction Del patients: ___ Ciudad: ___ Est ado×Cargo
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It is a financial aid application form provided by Methodist Rehab.
Patients seeking financial assistance for medical treatment at Methodist Rehab.
Patients need to provide personal and financial information as requested on the form.
The purpose is to assess the financial need of patients seeking assistance with medical bills.
Personal information, income details, medical expenses, and other financial data.
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