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Get OR 735-6941 2016-2024

N 1. Provide the form to your health care provider to complete Section 2.  Submit the form to the appropriate agency (court or DMV). If approved, the appropriate agency will provide you a copy. Health Care Provider: Read the information on the back of this form. Complete all information in Section 2. Submit the form to the appropriate agency or give it to the patient to submit to the appropriate agency.  Retain pink copy for your records Court: If you are t.

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