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5192582146 | tech.org | 1005 Oubliette Avenue, Windsor, ON N9A 4J8 | 33 Princess Street, Lexington, ON N8H 5C520232024 INFLUENZA VACCINE ORDER FORM Submit this completed form and the last 4 weeks
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Information that must be reported includes patient identification details, insurance information, details of the health services provided, and any relevant medical history.
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