Output Explorer

OFFICIAL RECORD-IMMEDIATE RESPONSE REQUESTED
RECORD OF PHYSICIANS'
PROFESSIONAL ACTIVITIES
DIRECTORY OF PHYSICIANS
Please cross-out any prior information
which is not applicable.
AMERICAN MEDICAL ASSOCIATION
535 N. Dearborn Street
Chicago, Illinois 60610
Dear Doctor:
Recent information indicates there may have been a change in your
professional mailing address and/or professional status. Therefore,
will you please take a moment to assist us in correcting our records.
00401370137
Thank You
GROUP NAME
Instructions
ADDRESS
1. Please answer every question on the basis of your current activities.
CITY-STATE-ZIP
2. Indicate any changes. Information which you provided previously has been
printed in this form. Please complete unanswered sections and make dis-
crete changes where applicable.
3. Upon completion, return the questionnaire at your earliest possible con-
venience, using the preaddressed envelope.
Contents
The questionnaire is divided into three sections:
1. Professional Activities-the types of activities in which each physician spends
00401370137 00401370137
the most time during an average week.
WM JEFFERSON DARBY MD
I1. Specialization-the time physicians spend in their major fields of specialization.
VANDERBILT UNIV SCH MED
Ill. Present Employment Status- the number of hours per average week spent
under various practice arrangements, by type of practice organization
NASHVILLE TENN 37232
or employer.
ADDRESS
CITY-STATE-ZIP
Source: https://www.industrydocuments.ucsf edu/docs/mzfm0227

Answer the question using only the OCR text from a single document page. Return only the answer, with no explanation. Preserve the answer wording from the OCR text when possible.