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Get UF Health RI0001 2015-2024

N of the University of Florida Board of Trustees for the benefit of the University of Florida College of Medicine, Shands Jacksonville Medical Center, Inc., Shands Teaching Hospital and Clinics, Inc., and Shands Recovery, LLC. Collectively, these entities are referred to as UF Health in this form. Patient’s Name Date of Birth Medical Record # Verification of Identity  Box 2 Box 1 h Driver License/State ID   h Personally known h Other: Box 5 Patient’s Address        .

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