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Kênh 555win: · 2025-08-23 12:15:11

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BROOMFIELD FAMILY PRACTICE NOTICE OF PRIVACY PRACTICES ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES and (Patients Name, Print) Date of Birth …

Broomfield Family Practice Office Policies and Procedures Office Hours: 00 a.m. to 5:00 p.m. and Saturday 9:00 a.m. to 1:00

FAMILY HISTORY: 1. Do any members of your family have any history of the following? ... icant conditions in your family that your health care provider should know about? No Yes, please exp …

Broomfield Family Practice Consent to discuss Private Healthcare Information (please print)

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Liver disease/Hepatitis Recurrent Ear Infections Seizures Urinary Tract Infections Vesicoureteral Reflux Vision Problems the child Diagnosis Family Member ADD/ADHD Alcohol/Drug Abuse …

If I do, it will not affect any actions already taken by the above named practice based upon this authorization. I may not be able to revoke this authorization if its purpose was to obtain …

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By signing below, you authorize the staff of Broomfield Family Practice to call and leave a detailed message on your voicemail, answering machine or with your designated person.

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