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Additionally, you are confirming that you have a current release from the physician/practitioner on file granting you permission to obtain information regarding his/her affiliation and privileges from our facility.
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| Name | Type | SSN | NPI | DOB | Facilities (PDF Generation) |
|---|---|---|---|---|---|
| {{ r.name }} | {{ r.practitionerType }} | {{ r.ssn }} | {{ r.npi }} | {{ r.dob }} |
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Status: {{ c.client.affiliationsEnabled ? "Active" : "Inactive" }}
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