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INITIAL EVALUATION SUBJECTIVE HISTORY WORKSHEET (Page 1) Patient Name: ___Date of Birth: ___ Date of Eval: ___SUBJECTIVE Age: ___ When did your symptoms start? ___ Hand Dominance: Right Left Date

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Kaiser Permanente Souformrn California is a specific form related to the reporting and administration of health care services provided by Kaiser Permanente in California.

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Typically, employers who offer health insurance plans through Kaiser Permanente in California are required to file the Kaiser Permanente Souformrn California.

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To fill out the Kaiser Permanente Souformrn California, one must gather relevant employee and coverage information, follow the instructions provided on the form, and ensure accurate data entry before submission.

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The purpose of the Kaiser Permanente Souformrn California is to ensure compliance with health care regulations and to report relevant information regarding health coverage and enrollment.

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The information that must be reported includes employee details, coverage start and end dates, types of coverage provided, and any dependent information.

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