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PATIENT INFORMATION FORM Suburban Women's Healthcare, P.C.______/___/___Name Date of Birth______Addresses #___ City______State______EmployerPosition___Marital Status: S M W D Sepsis Code___(circle
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Suburban Women's Healthcare PC is a healthcare provider that received financial assistance through the coronavirus bailouts.
Suburban Women's Healthcare PC is required to file the necessary reports related to the coronavirus bailouts.
The reports related to the coronavirus bailouts must be filled out according to the guidelines provided by the government.
The purpose of the reports related to the coronavirus bailouts is to provide transparency and accountability in the distribution of funds.
The reports must include details about the amount of financial assistance received, how the funds were used, and any other relevant information.
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