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Ten Mile Clinic 4574 N Ten Mile Rd Ste 120 Meridian ID 83646 (208) 8843376Main Clinic 1618 S Millennium Way Ste 100 Meridian ID 83642 (208) 8843376REQUEST FOR MEDICAL RECORDS TO ADA WEST DERMATOLOGY
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Individuals seeking dermatology services or treatment from ADA West Dermatology 4574 would need to fill out this form.
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ADA West Dermatology 4574 is a specific form or document related to dermatological practices or patient care, often used for administrative or billing purposes in dermatology settings.
Healthcare providers or facilities that offer dermatological services may be required to file ADA West Dermatology 4574 to report relevant patient information or billing details.
To fill out ADA West Dermatology 4574, follow the instructions provided with the form, ensuring all required fields are completed accurately, including patient information, treatment details, and billing codes.
The purpose of ADA West Dermatology 4574 is to facilitate the collection and reporting of essential patient and treatment information in the field of dermatology for administrative and billing purposes.
Information that must be reported on ADA West Dermatology 4574 includes patient demographics, treatment codes, dates of service, provider details, and any necessary billing information.
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