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Holder & Holder, LLC 211 Perimeter Center Parkway, Suite 1010 Atlanta, Georgia 30346 tel. (770) 3920090 fax (770) 3920029LEGAL REPRESENTATION AGREEMENT This Retention Agreement governs the retention
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Gather all necessary personal information such as name, address, contact information, insurance details, and identification.
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Complete all sections of the form accurately and legibly, ensuring that all information provided is up to date.
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Submit the completed form either in person at a Holzer Health System location or through the designated online portal.
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Holzer Health System in Gallipolis, OH is a healthcare system that provides medical services to the community.
Employees and employers who receive services from Holzer Health System in Gallipolis, OH may be required to file certain paperwork related to their healthcare.
To fill out paperwork related to Holzer Health System in Gallipolis, OH, individuals may need to provide personal information, medical history, and insurance details.
The purpose of Holzer Health System in Gallipolis, OH is to provide healthcare services and support to the community.
Information such as personal details, medical history, insurance information, and treatment received may need to be reported on paperwork related to Holzer Health System in Gallipolis, OH.
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