For other uses, see Dominic (disambiguation). Dominic is a name common among Roman Catholics and other Latin-Romans as a boys name. Originally from the late Roman-Italic name Dominicus its translation means Of Our Lord, Lordly, Belonging to God or of the Master.
ï· Call us at 1-888-693-3211. ï· Fax an eviCore healthcare request form (available online) to 1-888-693-3210. Also, to ease the administrative burden of requiring prior authorization of OB Ultrasound studies, providers may batch service requests for up to 12 weeks and cases may be reviewed retrospectively for.
Biddeford Recreation Department P.O. Box 586 Biddeford, Maine 04005 Tele: (207) 283-0841 ext 4210 Fax: (207) 286-3331 Email: bdunphe@biddefordmaine.org www.BiddefordRec.com Participant Information and Medical History Form Your Trip/ Tour /Clinic Date: _____ I) Personal and Medical Information â (This information is confidential