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Yellow Springs Primary Care, INC

FORMS

Caretaker Authorization Affidavit
Designation of Authorized Person to Sign Consent for Treatment
New Patient Welcome Letter
New Patient Registration
Adult New Patient Questionnaire
Pediatric New Patient Questionnaire
Request Medical Records To Be Sent
Request Medical Records From
Pediatric New Patient packet
Patient Nondiscrimination Policy
Notice of Privacy Practices
ACO Beneficiary Information Notice

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