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Get OK ODH Form 606 2013

Redentialing Application SECTION 3: CURRENT PROFESSIONAL PRACTICE Primary Specialty (or field of practice) Subspecialty % Of Time Secondary Specialty Subspecialty % Of Time Do you wish to be listed as: ___ Primary Care Provider ___ Specialist ___ Hospitalist ___ On-Call ___ Other (specify) If you are a primary care physician, list special diagnostic or treatment procedures performed in your office(s): ___ Yes ___ No Are you accepting new patients? ___ Yes ___ No Are you willing, in the.

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