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COVID-19 Emergency Relief Resources for PDX (and beyond)

COVID-19 Emergency Relief Resources for PDX (and beyond) 2025

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The document is a consent and financial responsibility form for patients of Connected Cardiovascular Care Associates. It includes authorizations for medical treatment, release of medical information, and financial policies regarding insurance coverage, payment responsibilities, and procedures for missed appointments. The document emphasizes the patient's obligation to provide accurate insurance information and outlines the consequences of non-payment. Additionally, it contains sections for patient information, medical history, and authorization to retrieve medication records.

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