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HealthReach Community Clinic 400 E Statesville Ave, Ste 300 Mooresville, NC 28115Phone: (704) 6631992 Fax: (704) 6632073Patients@healthreachclinic.orgPATIENT APPLICATION Revised January 2024Applicant

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Gather all necessary personal information, including name, date of birth, address, and contact information.

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Complete all sections of the health form, including medical history, insurance information, and reason for visit.

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What is healthreach community clinic health amp?

HealthReach Community Clinic Health Amp is a program that provides healthcare services to underprivileged communities, focusing on accessible and affordable healthcare.

Who is required to file healthreach community clinic health amp?

Organizations and individuals who provide health services through HealthReach Community Clinics are required to file the Health Amp form.

How to fill out healthreach community clinic health amp?

To fill out the HealthReach Community Clinic Health Amp, gather all necessary documentation, complete the form with accurate information, and submit it according to the provided guidelines.

What is the purpose of healthreach community clinic health amp?

The purpose of HealthReach Community Clinic Health Amp is to ensure comprehensive documentation and reporting for the services provided by the clinic, which supports funding and resources for community healthcare.

What information must be reported on healthreach community clinic health amp?

The information that must be reported includes patient demographics, services provided, funding received, and health outcomes.

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