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Internal Medicine Group 2301 House Avenue, Suite 300 Cheyenne, WY 82001 Fax 3076382656 Phone 3076354141 www.imgwy.comForm BPast Medical History Form Patient Name___Referring Doctor___Date of Birth___Primary
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Internal Medicine Group PC is a medical practice group that specializes in the diagnosis, treatment, and care of adult patients.
Internal Medicine Group PC is required to file by the designated personnel or authorized representatives of the practice group.
To fill out Internal Medicine Group PC, the designated personnel or authorized representatives need to provide accurate information about the practice group's financial and operational activities.
The purpose of Internal Medicine Group PC is to report the financial and operational status of the practice group to relevant authorities.
Information such as revenue, expenses, patient volume, services provided, and any other relevant financial and operational data of the practice group must be reported on Internal Medicine Group PC.
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