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2018 - Patient Information and Permanent Lifetime Signature

2018 - Patient Information and Permanent Lifetime Signature-2025

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The document is a comprehensive patient information form for Dr. Peter A. Martinez-Noda's medical practice, detailing personal, insurance, and medical history information required from patients. It includes sections on financial policies, assignment of benefits, HIPAA privacy practices, and no-show policies. The form emphasizes the importance of communication regarding appointments and payment responsibilities while ensuring compliance with healthcare regulations.

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