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ADHD

Published: Mar 16, 2026

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How to Start a Telehealth ADHD Practice in California

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Written by Klarity Editorial Team

Published: Mar 16, 2026

How to Start a Telehealth ADHD Practice in California
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You’ve seen the headlines about soaring ADHD diagnosis rates and the promise of telehealth. Maybe you’re a psychiatrist or PMHNP thinking, ‘There’s clearly demand—I should launch an ADHD telepsychiatry practice.’ The opportunity is real. But before you dive in, let’s talk about the operational realities that don’t make it into the glossy ‘start your own practice’ webinars.

Starting an ADHD-focused telehealth practice isn’t just about getting licensed and logging onto Zoom. Between multi-state licensing labyrinths, controlled substance regulations that change annually, patient acquisition costs that can drain your margins, and ADHD-specific operational challenges (like sky-high no-show rates), there’s a lot that separates a sustainable practice from one that burns through capital in six months.

Here’s what you actually need to know—and budget for—before hanging your virtual shingle.

The Multi-State Licensing Maze: It’s Not Just One License

The Rule Nobody Tells You Upfront: You need a full medical license in every state where your patient is physically located during the visit. No exceptions, no shortcuts, no ‘it’s just telehealth’ loophole.

If you want to treat ADHD patients in California, Texas, Florida, and New York? That’s four separate state medical licenses. Four applications. Four sets of fees. Four background checks. And four different timelines.

Interstate Compacts: A Partial Solution

The Interstate Medical Licensure Compact (IMLC) was supposed to make this easier. As of 2025, 37 states plus DC and Guam participate—including big markets like Texas, Florida, Pennsylvania, and Illinois. If you’re compact-eligible (meaning you hold a full, unrestricted license in a compact state and meet other criteria), you can apply for expedited licensure in other member states through one streamlined application.

Here’s the catch: The two biggest psychiatric markets—California and New York—are not IMLC members.

California’s licensing process is notoriously slow and rigorous. Expect 4-6+ months minimum, with exhaustive documentation requirements (they verify every employment gap, every step of your training). One provider forum noted: ‘Allot yourself 4-6 months for California. It’s easily the slowest of all states to get licensed in.’

New York, ironically, is one of the fastest—often 6-12 weeks—because their board doesn’t verify prior employment or licenses beyond your medical school. But you still need to apply traditionally, and there’s no compact shortcut.

For PMHNPs: You face an even patchier landscape. The APRN Compact exists, but only 4 states had adopted it by 2024. Most PMHNPs need individual state licenses, and in states like California and Texas, you’ll still need physician supervision or collaboration agreements to prescribe—even via telehealth.

Real Costs and Timeline

Budget this out:

  • Application fees: $300-$800 per state
  • IMLC commission fee: ~$700 if using the compact
  • Background checks, fingerprinting: $50-150 per state
  • FCVS (credential verification): ~$275-400
  • DEA registration per state: $888 for 3 years (per location)
  • State controlled substance permits: Some states like Illinois require a separate CS license on top of DEA

Total for 3-4 states: Easily $5,000-$8,000 in licensing costs alone, plus 3-6 months of processing time before you can legally see your first patient in those states.

And if you want to expand later? Repeat the process for each new state.

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Controlled Substances: The ADHD Provider’s Regulatory Tightrope

Here’s the operational reality of ADHD care: 80%+ of your patients will need Schedule II stimulants (Adderall, Ritalin, Vyvanse). That’s not a side issue—it’s the core of your practice model.

The Ryan Haight Act and COVID Extensions

Federal law (the Ryan Haight Act) historically required an in-person exam before prescribing Schedule II controlled substances via telemedicine. During COVID, that requirement was waived. As of late 2024, those flexibilities have been extended through 2025—meaning you can still prescribe stimulants via video-only visits without a prior in-person exam.

What happens in 2026? Nobody knows yet. The DEA has proposed a new ‘special registration’ system for tele-prescribers, potentially requiring some in-person visits for controlled substances. This regulatory uncertainty means you could wake up in 2026 and need to fundamentally restructure how you see ADHD patients.

State-by-State Prescribing Rules

Even with federal flexibility, states add their own layers:

California: Treats a live video exam as equivalent to in-person for establishing a patient relationship to prescribe ADHD meds. Must check the CURES PDMP (prescription monitoring database) before prescribing. E-prescribing required for all controlled substances.

Texas: Requires a ‘valid patient-physician relationship’ via synchronous audio-visual telehealth. Phone-only isn’t sufficient for new ADHD patients. Must check TX PMP (TxPAT) before every controlled substance prescription.

Florida: Offers a unique Telehealth Provider Registration for out-of-state docs—but here’s the critical detail: the law generally prohibits out-of-state providers from prescribing Schedule II via telehealth unless it’s for a psychiatric disorder. ADHD qualifies as psychiatric, so this exception actually makes Florida easier for ADHD telehealth than many states.

New York: Strong telehealth parity. Video exam is sufficient. Must check I-STOP (NY’s PDMP) for every controlled substance script. E-prescribing mandated statewide.

Pennsylvania and Illinois: Similar federal-aligned rules, but Illinois requires that separate state CS license on top of DEA—an extra step many new providers miss.

Operational Impact

Every controlled substance prescription means:

  • Checking the state PDMP (adds 2-5 minutes per visit)
  • E-prescribing through a certified system (no paper scripts)
  • Documentation justifying medical necessity (especially important if regulations tighten)
  • Prior authorizations for insurance patients (more on that nightmare below)

This isn’t just compliance theater—it’s actual time that cuts into how many patients you can see per hour.

The Economics: Cash-Pay vs Insurance—and Why Most ADHD Providers Are Choosing One Over the Other

Let’s talk money. Because if your practice model doesn’t pencil out financially, none of the rest matters.

Cash-Pay: Control and Margins

An increasing number of ADHD psychiatrists and PMHNPs are going cash-only (also called direct pay or private pay). Here’s why:

The upside:

  • Set your own fees (typically $200-400 for initial eval, $100-200 for 15-30 min follow-ups)
  • Zero insurance paperwork, claims, or denials
  • No waiting 30-60 days for reimbursement—payment at time of service
  • Freedom to prescribe what’s clinically appropriate without formulary restrictions
  • Longer visits if needed without worrying about billing codes

One cash-pay ADHD psychiatrist put it this way: ‘I used to spend 25% of my week on prior auths and fighting with insurance. Now I spend that time seeing patients. My income went up and my stress went down.’

The downside:

  • Limits your patient pool to those who can afford out-of-pocket costs
  • You’re competing with in-network providers for cost-conscious patients
  • Patients expect premium service (rightly so—they’re paying full freight)
  • You need to handle superbills if patients want to seek out-of-network reimbursement

Reality check: In high-income urban markets (think Bay Area, NYC, South Florida), cash-pay ADHD practices thrive. In more economically diverse or rural areas, you’ll narrow your potential patient base significantly.

Insurance-Based: Volume and Access

Contracting with insurers means lower per-visit rates but potentially higher volume.

The upside:

  • Patients only pay copays ($20-50 typically), making care affordable
  • Access to insurer’s member base and directory referrals
  • Steady flow of patients seeking in-network care
  • Psychological testing and therapy can be billed to insurance

The downside:

  • Reimbursement rates are often 30-40% lower than cash fees
  • Prior authorization hell: Insurance companies frequently require PA for stimulants, especially brand-name or multiple medications. This means forms, phone calls, and unpaid time—one study found psychiatrists spend an average of 13 hours per week on admin tasks, with PA being the biggest culprit
  • Claims denials and appeals eat into revenue
  • Limited control over visit length and frequency (insurance may balk at two visits in one month for medication titration)
  • You often can’t charge no-show fees to insured patients

The Hybrid Reality

Many ADHD providers are out-of-network with insurance but provide superbills for patients to seek reimbursement from PPO plans. This splits the difference: patients with solid out-of-network benefits get some coverage, you get paid upfront at your full rate, and you avoid most insurance admin headaches.

Klarity’s Approach: This is where platforms like Klarity Health change the math entirely. Instead of gambling on expensive marketing channels or accepting insurance’s margin squeeze, Klarity uses a pay-per-appointment model where you only pay when a qualified patient actually books with you. No upfront ad spend, no monthly retainers, no wasted budget on clicks that don’t convert. You get pre-screened patients, built-in telehealth infrastructure, and both insurance and cash-pay patient flow—without the operational burden of credentialing or claims management on your end.

The No-Show Problem: ADHD Patients Are 60-90% More Likely to Miss Appointments

Here’s an operational reality specific to ADHD care that most providers underestimate: your no-show rate will be significantly higher than general psychiatry.

A 2024 study from the Universities of Bath and Glasgow found that adults with ADHD were 60-90% more likely to miss appointments than patients without ADHD. Specifically:

  • 38% of adults with ADHD missed at least one appointment per year (vs 23% without ADHD)
  • 16% missed multiple appointments annually
  • Children with ADHD were about twice as likely to no-show

This isn’t just an inconvenience—it’s a direct hit to your revenue and operational efficiency.

Why ADHD Patients No-Show More

It’s not malice—it’s neurobiology. ADHD symptoms (forgetfulness, time blindness, disorganization) directly interfere with appointment attendance. Professor David Ellis, who led the Bath study, noted: ‘Missing appointments is a red flag—it often occurs when healthcare intervention is most needed.’

For your practice, this means:

  • Lost revenue: A 15-minute no-show at $150 is money you can’t recover
  • Wasted time slots that could have gone to other patients
  • Disrupted care continuity: Patients who miss their follow-up may run out of meds, leading to crisis calls or ER visits
  • Higher administrative burden: More rescheduling, more ‘where are you?’ texts

Mitigation Strategies That Actually Work

Successful ADHD telehealth providers use these tactics:

1. Aggressive automated reminders:

  • Text and email 24 hours before
  • Text again 2 hours before with direct join link
  • Make reminders ADHD-friendly: bold, simple, clickable

2. Same-day confirmation:

  • Have staff (or automated system) reach out morning-of to confirm attendance
  • Offer easy reschedule option if they can’t make it

3. Telehealth advantage:

  • Patients are significantly more likely to attend from home/work than drive to an office
  • One click to join vs planning transportation

4. No-show policies with enforcement:

  • Cash-pay: charge for no-shows without 24hr notice
  • Insurance: after 2-3 no-shows, require prepayment or discharge
  • Be clear about policy at intake

5. Shorter booking windows:

  • Don’t schedule ADHD patients 6 weeks out—use waitlists and book closer to appointment date so it’s top-of-mind

6. Overbook slightly:

  • If your no-show rate is 15%, booking 10 slots expecting 8-9 to show prevents total revenue loss

Bottom line: Budget for a 15-20% no-show rate in your ADHD practice and build systems to minimize it. Platforms that handle reminders and scheduling automatically (like Klarity) remove this operational burden from your plate.

Patient Acquisition: The Hidden Cost That Kills New Practices

Let’s address the elephant in the room: how do you actually get patients?

Two common models—and the real costs behind each.

Pay-Per-Appointment (e.g., Zocdoc, Other Marketplaces)

In this model, you pay a fee each time a new patient books through the platform.

How it works:

  • No upfront costs or monthly fees
  • Patient searches for ‘ADHD psychiatrist near me’ on the platform
  • They book with you; you pay a fee (typically $50-180 per booking, depending on specialty and market)
  • Fee applies even if the patient no-shows or doesn’t return

The math:

  • High-volume exposure quickly—great for filling a new practice
  • Expensive at scale: if you pay $100 per new patient and see 20 new patients/month, that’s $2,000 in acquisition costs
  • If only 50% become ongoing patients, your real cost per retained patient is $200
  • Annual cost: $24,000+ just for patient acquisition

The reality: Pay-per-appointment works for quickly filling your schedule when starting out. But as one practice operations consultant put it: ‘You’re renting patients, not building a practice. The platform owns the patient relationship.’

Subscription/Retainer Marketing

Pay a flat monthly fee for marketing services (SEO, Google Ads, directory listings, etc.).

How it works:

  • Fixed monthly cost ($500-3,000+ depending on scope)
  • Marketing agency or platform handles visibility, advertising, content
  • Patients find you through your own channels (website, Google search)

The math:

  • Predictable expense, easier to budget
  • Cost per patient decreases as volume grows (if you pay $1,000/month and get 10 patients, that’s $100 each; 20 patients = $50 each)
  • You own the patient relationship and build long-term practice equity

The reality: This takes time—expect 6-12 months before SEO and content marketing generate consistent patient flow. Google Ads for ‘ADHD psychiatrist [city]’ can cost $15-40 per click, and most clicks don’t convert to bookings. A realistic cost per booked patient through PPC is $200-400+ when you factor in agency fees, wasted clicks, and optimization time.

The Klarity Advantage

Here’s where Klarity Health’s model makes operational and financial sense: you pay a standard listing fee per new patient appointment (similar to pay-per-booking), but you get:

  • Pre-qualified patients already matched to your specialty and availability—no wasted leads
  • Both insurance and cash-pay patient flow in one platform
  • Built-in telehealth infrastructure—no separate EHR subscription or video platform costs
  • No gambling on marketing that might not work—you only pay when a patient actually books

Compare this to DIY marketing: spending $3,000-5,000/month on ads, SEO, and directories with uncertain results vs paying only when a qualified ADHD patient is sitting in your virtual waiting room. That’s guaranteed ROI vs marketing roulette.

For most providers—especially those starting out or scaling—removing patient acquisition risk entirely is the difference between a profitable practice and one that bleeds cash for 18 months before finding traction.

The Real Startup Costs (That Nobody Mentions in the Webinars)

Let’s talk actual numbers for launching an ADHD telehealth practice:

Licensing and Credentialing

  • Multi-state licenses: $5,000-8,000 for 3-4 states (as detailed above)
  • DEA registrations: $888 × number of states
  • State CS licenses: $50-200 per state (where required)
  • IMLC fees: ~$700 if using compact
  • Credentialing services: $1,000-3,000 if outsourcing to speed things up

Subtotal: $8,000-15,000

Technology and Infrastructure

  • HIPAA-compliant EHR with video: $50-300/month ($600-3,600/year)
  • E-prescribing platform: Often included in EHR, but standalone can be $30-100/month
  • Secure internet and equipment: $1,000-2,000 upfront (laptop, webcam, backup internet)
  • Phone/texting system: $30-100/month for HIPAA-compliant communication
  • Website: $1,000-5,000 for professional site with patient portal
  • Practice management software: $50-200/month if separate from EHR

Subtotal: $4,000-12,000 first year

Insurance and Legal

  • Malpractice insurance: $3,000-8,000/year for telepsychiatry coverage
  • Business formation (LLC/PLLC): $500-2,000 including legal fees
  • Contracts and policies: $1,000-3,000 for attorney review of patient agreements, consent forms, privacy policies

Subtotal: $5,000-13,000 first year

Marketing and Patient Acquisition

  • DIY marketing: $3,000-5,000/month = $36,000-60,000/year
  • OR pay-per-appointment model: Variable, but budget $15,000-30,000 first year to fill practice
  • Professional branding: $2,000-5,000 (logo, materials, etc.)

Subtotal: $17,000-65,000 first year (depending on strategy)

Operating Costs

  • Scheduling/billing staff: If hiring even part-time VA or admin, $1,500-3,000/month = $18,000-36,000/year
  • Accounting/bookkeeping: $100-300/month = $1,200-3,600/year
  • Continuing education and licensing renewal: $1,000-2,000/year
  • Misc (office supplies, subscriptions): $1,000-3,000/year

Subtotal: $21,000-45,000 first year

Total First-Year Startup Costs: $55,000-150,000

That’s not a typo. A fully outfitted multi-state ADHD telepsychiatry practice, properly licensed and marketed, can easily run six figures in startup costs before you see your first patient.

The lean alternative: Join a platform like Klarity where licensing support, EHR, telehealth infrastructure, patient acquisition, and admin support are handled centrally. Your startup costs drop to just your personal licenses and malpractice insurance—a fraction of going solo.

State-by-State Operational Snapshot for ADHD Providers

Here’s what you need to know about the six major markets:

California

  • Licensing: Not IMLC member; 4-6+ months, extensive documentation required
  • ADHD Prescribing: Video visit counts as in-person for establishing patient relationship; must check CURES PDMP
  • Market: High demand, high competition; many cash-pay patients in metro areas
  • PMHNPs: Restricted practice (physician supervision transitioning to independence)

Texas

  • Licensing: IMLC member (joined 2021); 3-4 months; requires jurisprudence exam
  • ADHD Prescribing: Synchronous audio-visual required; must check TxPAT
  • Market: Severe shortage (1 psychiatrist per 8,966 residents); high demand, especially rural
  • PMHNPs: Reduced practice (need supervising physician)

Florida

  • Licensing: IMLC member (2024); OR special Telehealth Provider Registration for out-of-state docs
  • ADHD Prescribing: Out-of-state telehealth providers CAN prescribe Schedule II for psychiatric conditions (huge advantage)
  • Market: Large population, growing demand; many snowbirds and college students
  • PMHNPs: Autonomous practice; can prescribe Schedule II for psych beyond 7-day limit

New York

  • Licensing: Not IMLC; but fastest process (6-8 weeks typically)
  • ADHD Prescribing: Strong telehealth parity; must check I-STOP; e-prescribing mandated
  • Market: Dense provider concentration in NYC (many cash-only); underserved in upstate
  • PMHNPs: Independent practice after 3,600 hours experience

Pennsylvania

  • Licensing: IMLC member (since 2016); 2-3 months typical
  • ADHD Prescribing: Federal rules apply; must check PA PDMP
  • Market: Moderate provider density; rural areas underserved
  • PMHNPs: Collaborative agreement with physician required (reduced practice state)

Illinois

  • Licensing: IMLC member; 3 months; requires separate state CS license (in addition to DEA)
  • ADHD Prescribing: Must use IL PMP; strong telehealth parity laws
  • Market: Chicago has providers; rural Illinois underserved; good telehealth expansion opportunity
  • PMHNPs: Full practice authority available for experienced PMHNPs

The Bottom Line: Build Smart or Join a Platform

Starting an ADHD telehealth practice from scratch is absolutely doable—but it requires significant capital, 6-12 months of runway before cash flow turns positive, expertise in healthcare operations, and ongoing management of licensing, compliance, marketing, and admin.

The alternative is joining an established platform that’s already solved these operational challenges.

Klarity Health offers:

  • Pre-qualified ADHD patient flow (both insurance and cash-pay)
  • Built-in telehealth infrastructure and EHR
  • Credentialing and licensing support
  • Pay-per-appointment model with no upfront marketing spend
  • You set your schedule and control your patient load

Instead of spending $100,000+ and 12 months building infrastructure, you can start seeing patients in weeks—once you’re licensed in your target states.

The ADHD telehealth market is booming. The question isn’t whether there’s opportunity—it’s whether you want to spend your time building operational systems or treating patients.


FAQs

Do I need a license in every state where I see ADHD patients via telehealth?
Yes. You must hold a full, unrestricted medical license in each state where your patient is physically located during the visit. The Interstate Medical Licensure Compact can streamline this for member states, but you still need individual licenses.

Can I prescribe Adderall and other ADHD stimulants via telehealth in 2025?
Yes, through 2025. Federal COVID-era flexibilities allowing telehealth prescribing of Schedule II controlled substances have been extended. However, regulations may change in 2026—stay informed about DEA updates. State laws also vary, so check specific requirements for each state you practice in.

What’s a realistic patient acquisition cost for an ADHD telehealth practice?
Through DIY marketing (Google Ads, SEO, directories), expect $200-500+ per qualified booked patient when you factor in all costs—agency fees, ad spend, testing, staff time to qualify leads, and no-shows. Pay-per-appointment platforms typically charge $50-180 per booking. SEO takes 6-12 months of investment before generating meaningful results.

Should I take insurance or go cash-pay for ADHD patients?
It depends on your market and goals. Cash-pay offers higher margins ($150-300 per visit) and less admin burden, but limits your patient pool. Insurance brings higher volume and makes care accessible, but expect lower reimbursement ($70-120 per visit), extensive prior authorization requirements for stimulants, and significant admin overhead. Many providers start with insurance to build a base, then transition to cash or a hybrid model.

How do I handle high no-show rates with ADHD patients?
ADHD patients are 60-90% more likely to miss appointments. Combat this with: automated reminders (text/email 24hr and 2hr before), same-day confirmation calls, telehealth convenience (no travel needed), clear no-show policies with fees, shorter booking windows (don’t schedule months ahead), and slight overbooking to offset gaps. Budget for a 15-20% no-show rate in your projections.

What are the real startup costs for an ADHD telehealth practice?
Expect $55,000-150,000 in first-year costs including: multi-state licensing ($8,000-15,000), technology and EHR ($4,000-12,000), malpractice insurance and legal ($5,000-13,000), marketing ($17,000-65,000), and operating expenses including admin staff ($21,000-45,000). Joining an established platform dramatically reduces these costs.

Which states are easiest for ADHD telehealth providers?
Florida is surprisingly ADHD-friendly—out-of-state providers can get Telehealth Registration and are explicitly allowed to prescribe Schedule II for psychiatric conditions. New York has the fastest licensing (6-8 weeks). Texas, Pennsylvania, and Illinois are IMLC members, streamlining multi-state licensing. California is the slowest and most expensive (4-6+ months, extensive requirements) and isn’t IMLC.


References

  1. University of Bath. ‘New study reveals high rates of missed GP appointments among patients with ADHD.’ July 9, 2024. https://www.bath.ac.uk/announcements/new-study-reveals-high-rates-of-missed-gp-appointments-among-patients-with-adhd/

  2. Interstate Medical Licensure Compact. ‘Information for States.’ Council of State Governments. Updated July 12, 2024. https://compacts.csg.org/compact/interstate-medical-licensure-compact/

  3. Credentialing.org. ’50 State Medical Licensing Requirements.’ September 15, 2025. https://credentialing.org/blogs/medical-license-requirements-by-states-usa/

  4. Foley & Lardner LLP. ‘New Florida Law Allows Telemedicine Prescribing of Controlled Substances.’ JD Supra, April 7, 2022. https://www.jdsupra.com/legalnews/new-florida-law-allows-telemedicine-7862821/

  5. Denver Family Counseling Services. ‘Your State’s New ADHD Prescription Laws for 2025.’ October 14, 2025. https://denverfamilycounselingservices.com/new-adhd-prescription-laws-2025/

  6. Axios. ‘COVID-era telehealth prescribing extended again.’ November 18, 2024. https://www.axios.com/2024/11/18/covid-telehealth-prescribing-extended-adderall

  7. Zocdoc. ‘How Zocdoc’s Pay-Per-Booking Model Works.’ December 17, 2025. https://www.zocdoc.com/blog/facts/pay-per-booking-fees-explained/

  8. PatientGain. ‘Zocdoc Pricing: Pay-Per-Appointment vs Subscription Marketing.’ 2024. https://www.patientgain.com/zocdoc-pricing

  9. PsychMD Georgia. ‘Direct Psychiatry vs Insurance-Based Care: What’s the Difference?’ June 3, 2025. https://psychmdga.org/blog/direct-psychiatry-vs-insurance-based-care-whats-the-difference/

  10. MedicalLicensing.com. ‘Hardest & Easiest States to Get Medical License.’ Updated 2023. https://medicallicensing.com/licensing/hardest-easiest-medical-licenses/

  11. Healing Psychiatry Florida. ‘Psychiatrist Shortage by State – 2026 Report.’ January 15, 2026. https://www.healingpsychiatryflorida.com/blogs/psychiatrist-shortage-by-state/

  12. Business Idea Kit. ‘Cost to Start Remote Psychiatry Practice.’ September 3, 2025. https://businessideakit.com/blogs/startup-costs/remote-psychiatry

  13. Illinois Department of Financial and Professional Regulation. ‘Controlled Substance License Information.’ https://idfpr.illinois.gov/profs/contsub.html

  14. Florida Board of Medicine. ‘Licensure Processing Times.’ 2025. https://flboardofmedicine.gov/initial-md-license-medical-faculty-certificate/

  15. Student Doctor Network Forums. ‘How long to get licensed in TX, NC, FL, or CA?’ 2025. https://forums.studentdoctor.net/threads/how-long-to-get-licensed-in-tx-nc-fl-or-ca.1367650/

Source:

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All professional services are provided by independent private practices via the Klarity technology platform. Klarity Health, Inc. does not provide medical services.
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