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Get and Sign Patient Demographic Sheet Patient Information

Get and Sign Patient Demographic Sheet Patient Information

Use a demographic sheet 0 template to make your document workflow more streamlined.

Eligiblee E F Noot Eligible G A Medicaid Enrolled No Health Insurance American Indian or o Alaskan Native Underin nsured served by FQHC RHC or o deputized provvider CHIP Other underinnsured Has heealth insurance tha at coovers vaccines are not ccovered by insurannce. In addition to t receive VFC vaccine underinsureed children must bbe vaccinated throough a Federally Q Qualified Health C Center FQHC or Rural Heealth Clinic RHC or under an appro roved deputized prrovider. V Otheer underinsured...
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