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Return Signed RX via Fax to: 315.469.9744IV Antibiotic Referral Form To:From:Intake Number: 315.492.1964Phone Number:Date:Number of Pages, Including Cover:Patient Name:DOB:Diagnosis/ICD10:Allergies:Initiation/Continuation
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Louisiana state tax forms such as the Louisiana Resident Income Tax Return (Form IT-540) are frequently used in Louisiana.
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Information such as income earned, deductions, credits, and personal information must be reported on Louisiana tax forms.
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