mracupuncture.com · practitioner, another health care provider, a health plan, my employer or a...

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Page 1: mracupuncture.com · practitioner, another health care provider, a health plan, my employer or a health care clearinghouse. This identifiable health information relates to my past
Page 2: mracupuncture.com · practitioner, another health care provider, a health plan, my employer or a health care clearinghouse. This identifiable health information relates to my past
Page 3: mracupuncture.com · practitioner, another health care provider, a health plan, my employer or a health care clearinghouse. This identifiable health information relates to my past
Page 4: mracupuncture.com · practitioner, another health care provider, a health plan, my employer or a health care clearinghouse. This identifiable health information relates to my past
Page 5: mracupuncture.com · practitioner, another health care provider, a health plan, my employer or a health care clearinghouse. This identifiable health information relates to my past
Page 6: mracupuncture.com · practitioner, another health care provider, a health plan, my employer or a health care clearinghouse. This identifiable health information relates to my past
Page 7: mracupuncture.com · practitioner, another health care provider, a health plan, my employer or a health care clearinghouse. This identifiable health information relates to my past
Page 8: mracupuncture.com · practitioner, another health care provider, a health plan, my employer or a health care clearinghouse. This identifiable health information relates to my past
Page 9: mracupuncture.com · practitioner, another health care provider, a health plan, my employer or a health care clearinghouse. This identifiable health information relates to my past
Page 10: mracupuncture.com · practitioner, another health care provider, a health plan, my employer or a health care clearinghouse. This identifiable health information relates to my past