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Account Number
First Name
Last Name
Patient First Name (N/A if you are the patient)
Patient Last Name (N/A if you are the patient)
Relationship to Patient (N/A if you are the patient)
Email
Phone (xxx-xxx-xxxx)
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Location where services took place
Bartow Regional Medical Center {BRMC}
BayCare Alliant Hospital {BAH}
Mease Countryside Hospital {MCH}
Mease Dunedin Hospital {MDH}
Morton Plant Hospital {MPH}
Morton Plant North Bay Hospital {MPNBH}
South Florida Baptist Hospital {SFBH}
St. Anthony's Hospital {SAH}
St. Joseph's Children's Hospital
St. Joseph's Hospital {SJH}
St. Joseph's Hospital
St. Joseph's Hospital-North {SJHN}
St. Joseph's Hospital-South {SJHS}
St. Joseph's Women's Hospital {SJWH}
Winter Haven Hospital {WHH}
Winter Haven Women's Hospital
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Last (4) Digits of Patient Social Security Number
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