PA Provider Referral Form draft without signature line

Department of Health

This government document is issued by Department of Health for use in Pennsylvania

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File Details: PDF (50.3 KB)
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:-o2sxg2obgu&q=https://www.health.pa.gov/topics/Documents/Programs/Tobacco/PA%2520Provider%2520Referral%2520Form%2520draft%2520without%2520signature%2520line.pdf&sa=U&ved=2ahUKEwjbtPPzs9D8AhUVolwKHUUuBnw4UBAWegQICBAC&usg=AOvVaw0Db-ypeOQaE8ZWFhAnBUbB

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