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The document is an intake form for Chena Obstetrics & Gynecology, detailing patient information collection, financial policies, insurance details, and authorization for the release of health information. It outlines the responsibilities of patients regarding payment and insurance updates, as well as their rights under HIPAA concerning privacy practices.

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Versions	Form popularity	Fillable & printable
2022	4.5 Satisfied (63 Votes)
2011	4 Satisfied (54 Votes)

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