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Application for District Health Board registration Use this form to register individual departments of your District Health Board with ACC. 1. DHB department details This form was completed on: [dd month yyy] District H
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Document Date: 2013-10-06 18:59:49


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pre-printed bank deposit slip / /

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Physiotherapy / Occupational therapy / /

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INFORMATION Organisation / District Health Board / /

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Nursing Podiatrist Emergency department Occupational therapy Speech therapist General Practitioner / Audiologist General surgeon / specialists Counsellor Inpatient stay Physiotherapy Dental surgeon / department Occupational therapy Speech therapist General Practitioner Orthopaedic surgeon / reconstructive surgeon Diagnostic radiologist Nursing Podiatrist / Diagnostic radiologist Nursing Podiatrist Emergency department Occupational therapy Speech therapist / Counsellor Inpatient stay Physiotherapy Dental surgeon Internal medicine specialist / /

Technology

cellular telephone / /

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