Contact Information


INSTRUCTIONS FOR LEAVING MESSAGES AND/OR DISCUSSING YOUR MEDICAL CONDITION WITH OTHERS

As of this date:

SPEAK ONLY TO ME

OK TO SPEAK TO MY SPOUSE

OK TO SPEAK TO MY PARENTS

OK TO LEAVE MESSAGE ON MY ANSWERING MACHINE

OK TO LEAVE MESSAGE ON MY VOICEMAIL

OTHER

BY SIGNING YOU ARE AGREEING THAT ALL OF THE INFORMATION ABOVE IS ACCURATE.

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Document name: Contact Information
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Timestamp Audit
May 25, 2021 10:38 pm CSTContact Information Uploaded by Derek Lang - langnewpatient@gmail.com IP 174.108.1.127