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PATIENT REGISTRATION FORM(520v)John R. Burroughs, MD, Today Date: ___ Date of Birth: ___ Gender: (circle) F M Patient Name: ___ First MI Last Nickname Address: ___ Street Apt/Ste City State Zip EMAIL:

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The Travis County Commissioners Court is the governing body for Travis County, Texas, responsible for overseeing the county's executive functions, managing budgets, and making policy decisions.

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