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REGISTRATION FORMAT:
___/___/___PATIENT INFORMATION:
Patient Name: ___
Address: ___
City: ___State: ___Zip___Email: ___
Telephone: (home) ___(Work) ___Cell: ___
Sex: ___M___FDate of Birth: ___/___/___INSURANCE
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What is idgroup group?
The idgroup group is a specific classification or category used for reporting purposes, often relating to certain tax, employment, or regulatory requirements.
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