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John H. Perriton, D.C. Travis W. Sullivan, D.C. 101 E Broadway St Prosper, TX 750782024 *Blue or Black Ink ONLY*PATIENT INFORMATION Todays Date:Completed By (circle one): Self / Guardian / Power of
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MayJune 07 WebPDF is an online form used for reporting information related to Alzheimer's disease and dementia, which allows healthcare providers to submit necessary data electronically.
Healthcare professionals and organizations that provide care for individuals diagnosed with Alzheimer's disease or dementia are typically required to file this report.
To fill out the form, follow the provided instructions online, ensuring all required fields are completed accurately, and submit it through the designated web portal.
The purpose of this form is to collect data on Alzheimer's disease and dementia cases to improve research, healthcare practices, and policy-making related to these conditions.
Information required typically includes patient demographics, diagnosis details, treatment plans, and outcomes associated with Alzheimer's disease and dementia.
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