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Date: ___Office Use Only
Chart #:___WELCOME! Please provide your license, dental and medical insurance cards for our records. (We do not accept Medicare.) Patient Information
Patient Name: ___
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What is choose form right chart?
Choose form right chart is a document used to select the appropriate chart for a specific data set.
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The information reported on choose form right chart includes the data set, the chosen chart, and any notes or explanations.
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