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FL Abortion Certification Form 2016-2025 free printable template

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State of Florida Abortion Certification Form SECTION I 1. Recipient s Name 2. Address 3. Medicaid Identification Number 4. On the basis of my professional judgement I have performed an abortion on the above named recipient for the following reason The woman suffers from a physical disorder physical injury or physical illness including a lifeendangering physical condition caused or arising from the pregnancy itself that would place the woman in danger of death unless an abortion is performed*...
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Healthcare Providers: Healthcare professionals may need this paperwork to document patient history or for compliance with medical regulations.
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Proof of abortion paperwork is documentation that verifies a medical abortion has taken place.
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