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Participation Cardiac Sports ScreeningCONTACT DETAILS Patient Forename:Home telephone:Surname:Mobile telephone:DOB:Email address:Parent/Guardian If patient is under 16 years of age, please provide

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This information must be a detailed report or form required by federal, state, or local government authorities to disclose financial, operational, or tax-related data.

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The information reported must include details such as income, expenses, assets, liabilities, and any other relevant data specified by the governing authority.