NHIN,APPLICATION PROXY (24) NEW PERSON (200)

Name	Value
NAME	NHIN,APPLICATION PROXY
SIGNATURE BLOCK PRINTED NAME	APPLICATION PROXY NHIN
SECONDARY MENU OPTIONS
TIMESTAMP	2026-06-22 17:19:24
DATE ENTERED	2026-06-22 00:00:00
CREATOR	PATCH,USER
USER CLASS	User Class: APPLICATION PROXY ISPRIMARY: Yes