div class=ts-pagebutton class=gotoPage data-page=1Page 1button div class=ts-imagea href=https:reader043vdocumentsmxreader043viewer20220309175b68250a7f8b9a68538c31ffhtml5page1jpg target=_blank img data-url=-one-is-completed-by-your-primary-care-physician-prior-to-your-visit-wehtmlpage=1 data-page=1 class=ts-thumb lazyload alt=Page 1: · one is completed by your primary care physician prior to your visit *We do not accept workmans comp cases or auto identification Of deceased patients loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader043vdocumentsmxreader043viewer20220309175b68250a7f8b9a68538c31ffhtml5thumbnails1jpg width=140 height=200 adivdivdiv class=ts-pagebutton class=gotoPage data-page=2Page 2button div class=ts-imagea href=https:reader043vdocumentsmxreader043viewer20220309175b68250a7f8b9a68538c31ffhtml5page2jpg target=_blank img 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or auto identification Of deceased patients loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader043vdocumentsmxreader043viewer20220309175b68250a7f8b9a68538c31ffhtml5thumbnails3jpg width=140 height=200 adivdivdiv class=ts-pagebutton class=gotoPage data-page=4Page 4button div class=ts-imagea href=https:reader043vdocumentsmxreader043viewer20220309175b68250a7f8b9a68538c31ffhtml5page4jpg target=_blank img data-url=-one-is-completed-by-your-primary-care-physician-prior-to-your-visit-wehtmlpage=4 data-page=4 class=ts-thumb lazyload alt=Page 4: · one is completed by your primary care physician prior to your visit *We do not accept workmans comp cases or auto identification Of deceased patients loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC 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