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 Patient Forms FYZICAL Therapy & Balance Centers PBC 2020-2023

Patient Forms FYZICAL Therapy & Balance Centers PBC 2020-2023

Use a fyzicalpbc 2020 template to make your document workflow more streamlined.

By the Health Insurance Portability and Accountability Act HIPAA I have been presented with a brochure outlining these practices Yes NO I have received a copy of the Summary of the Florida Client s Bill of Rights and Responsibilities Yes No Client/Responsible Party SignatureDate Legal Representation if applicable Attorney s Name CLIENT HEALTH QUESTIONNAIRE FYZICAL Therapy Balance Centers Name Age Date // Please describe your Current Complaint or Limitation Please tell us when your condition...
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