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Impact Yadkin/Collide Church Medical Release/Participant Form June 510, 2022 PARTICIPANT INFORMATION (please print legibly) Name (last)___ (First)___ Date of Birth___/___/___ Age:___ Sex__ Home Address:___City:___State:___Zip:___
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Impact YadkinCollide Church Medical is a form that needs to be filled out by certain individuals or organizations to report medical impacts made by the church.
Certain individuals or organizations that have been involved in providing medical services through the church are required to file Impact YadkinCollide Church Medical.
Impact YadkinCollide Church Medical can be filled out by providing all the necessary information regarding medical impacts made by the church in the designated sections of the form.
The purpose of Impact YadkinCollide Church Medical is to report and document the medical impacts made by the church for record-keeping and compliance purposes.
Information regarding the medical services provided by the church, the number of patients served, impact on the community, and any other relevant details must be reported on Impact YadkinCollide Church Medical.
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