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Elite Integrative Medical 153 South Dozen Drive, Beverly Hills, California 90211Patient Name___ Date: ___ Email: SS #/SIN DOB Male Female Age___ Height___ Weight___ Home phone: Cell Phone: Check appropriate
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This form is used to report integrative medical services provided by the clinic located in Beverly Hills, California.
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The clinic offering integrative medical services in Beverly Hills is required to file this form.
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The form should be filled out with the details of the integrative medical services provided, including patient information and billing details.
What is the purpose of wwwyellowpagescombeverly-hills-camipelite integrative medical 153?
The purpose of this form is to ensure accurate reporting and billing for integrative medical services provided.
What information must be reported on wwwyellowpagescombeverly-hills-camipelite integrative medical 153?
The form must include details such as the type of integrative medical services provided, patient names, dates of service, and billing information.
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