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Directory Results for InterCare Training understands that a situation may arise when you wish to lodge a complaint or to INTERCARE VASCULAR DIAGNOSTIC CENTER PATIENT INTAKE TESTING FACILITY NAME: SITE ID#: Address: Telephone: Fax: PATIENT DEMOGRAPHICS First Name: Last Name: Date of Birth: Sex: Middle Initial: M/F Race: SSN: Responsible Party:

InterCare Training understands that a situation may arise when you wish to lodge a complaint or
INTERCARE VASCULAR DIAGNOSTIC CENTER PATIENT INTAKE TESTING FACILITY NAME: SITE ID#: Address: Telephone: Fax: PATIENT DEMOGRAPHICS First Name: Last Name: Date of Birth: Sex: Middle Initial: M/F Race: SSN: Responsible Party: