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Get Oh Christ Hospital Orthopaedic Associates Hipaa Form 2012-2024

: Emergency Contact Name: Phone #: Insurance Primary: Address: Secondary: Address: Patient Insurance Coverage Responsibility Disclaimer and Authorization I understand that it is my responsibility to know if The Christ Hospital Orthopaedic Associates are an authorized provider according to my insurance contract. If for any reason my insurance contract is not valid or any fees are not covered by my insurance contract, I am responsible for payment of all charges. I also understand that The Chr.

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