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Y: The full name of your hospital or facility. Facility Tax ID: The facility/hospital Tax I.D. (including any applicable suffixes). Attending Provider: First and Last Name of the Doctor who will be attending to the patient s care. Attending's Phone: Phone number of the attending s office, (our physician may need to call the attending, we will notify you first). UR Contact: Name of the person at the hospital/facility that will be working with us for continued stay fax reviews. UR Contact Phon.

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