Confidential New Patient Information Form - Trimac Dental
FINAL – DHQP and NCEZID cleared. Form Approved. OMB Control No.: 0920-0572. Expiration date: 8/31/2021. Public reporting burden of this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. ................
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