Returning the care factor

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Form - Test

Please note (if applicable) - Parents/Caregivers, if there is a Court Order in place for children from birth to 16 years regarding custodial rights of the child, then a copy of this Order is required for scanning into the child's medical chart.

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As the patient is under 17 years of age, please provide the payer's Medicare details: 


By becoming a patient of Radius Medical Centre and signing this new patient form, I agree and consent to the following:

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13/06/2024