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REPORT OF MEDICAL HISTORY (This information is for official and medically confidential use only and will not be released to unauthorized persons.) Form Approved OMB No. 0704-0413 Expires Oct 31, 2006
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The return completed form is a document that must be filled out and submitted to report certain information.
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Any individual or organization who meets the criteria set by tax authorities must file the return completed form.
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The return completed form typically requires reporting of income, expenses, deductions, and any other related financial information.
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