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AUTHORIZATION SHEET Practice / Facility Name: TERMS/CONDITIONS: Submitter ensures that all data submitted to Office Ally is valid and represents services performed accurately. Office Ally shall not
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Submitter ensures that all necessary information and documentation is accurately submitted.
The person or entity responsible for submitting the required information is required to file submitter ensures that all.
Submitter ensures that all can be filled out by providing all the requested information and supporting documentation.
The purpose of submitter ensures that all is to ensure that all necessary information is provided accurately and on time.
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