aventino medical group – aventino medical group...roxy for the person accompanying a and...

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Page 1: Aventino Medical Group – Aventino Medical Group...ROXY FOR THE PERSON ACCOMPANYING A AND SELF-CERTIFICATION FORM FOR PARENTS LEGAL REPRESENTATIV I, the undersigned, (First name):
Page 2: Aventino Medical Group – Aventino Medical Group...ROXY FOR THE PERSON ACCOMPANYING A AND SELF-CERTIFICATION FORM FOR PARENTS LEGAL REPRESENTATIV I, the undersigned, (First name):