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Lab to Call Doctor:STANDARD ORDER Format:Date Received in Lab:Patient Name:Printing Information:MF DOB:Shoe Size:Phone: Fax:(800) 3015835 (435) 2518500 (435) 2518505www.motion.conductors Name:Shoe

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My doctor provided a is a form that contains medical information and recommendations provided by a healthcare provider.

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The patient or their legal guardian is required to file the doctor provided a.

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