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Oregon Health & Science University Hospitals and Clinics OC4501×OC4501* REQUEST FOR TRANSGENDER HEALTH SERVICESACCOUNT NO. MED. REC. NO. NAME BIRTHDATEPatient Identification Page 1 of 1Fax this form
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Visit the university health services website or office to obtain the necessary forms.
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Faculty and staff members who require medical assistance while working at the university.
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