![75362424-patient-fax-referral-form-michigan-cancer-consortium-michigancancer](https://cdn.cocodoc.com/cocodoc-form/png/75362424--PATIENT-FAX-REFERRAL-FORM-Michigan-Cancer-Consortium-michigancancer--x-01.png)
PATIENT FAX REFERRAL FORM - Michigan Cancer Consortium - michigancancer
Bp/wisewoman/colorectal patient fax referral form fax to: 1-800-261-6259 today s date use this form to refer patients who are ready to quit tobacco in the next 30 days to the michigan tobacco quitline. provider(s): complete this section provider...
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