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Registration form Pharmacy name/number:PCP:Patient information Last name:First:Middle: Mr. Mrs. Miss Ms. Is this your legal name? If not, what is your legal name? Yes No(Former name):Street address:Apt.
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Pain Management Associates PA is a medical practice specializing in the management of pain.
Healthcare providers or facilities associated with Pain Management Associates PA may be required to file.
The form can be filled out either electronically or by hand with all required information.
The purpose is to report information related to the management of pain for compliance and regulatory purposes.
Information such as patient demographics, treatment provided, and billing details must be reported.
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