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Peace Harbor Medical Center
400 Ninth Street
Florence,OR 97439
(800) 873-8253

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STEP 3
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Patient ID PatientMedicalRecordNumber First Name Last Name Birth Date PatientServiceBeginDate PatientServiceEndDate AdditionalInfo1 Additional Info 2 Additional Info 3 Additional Info 4 Additional Info 5 Additional Info 6 Amount
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Patient ID
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