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The document is a referral form for the Nurse Practitioner Led Clinic located in Oshawa, Ontario. It collects patient information, including personal details, medical history, and reasons for referral such as needing a primary care provider or specific health services. The form also includes sections for risk assessment and legal information, and it instructs the referrer to fax the completed form to Community Connection Services.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (50 Votes)
2016	4.1 Satisfied (55 Votes)

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