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Humboldt IPA Diabetes Eye Exam Referral and Report REFERRAL INFORMATION Referred By: Fax #: Referred To: Fax #: Reason for Referral: Patients Name: Date of Birth: Home Phone: Gender: M F Insurance:.

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  3. Press the arrow with the inscription Next to move from one field to another.
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  5. Insert the date.
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  7. Press Done and save the resulting document.

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