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State of California Health and Human Services Agency Department of Health Care Services DAVID MAXWELL-JOLLY Director ARNOLD SCHWARZENEGGER Governor October 7th, 2009 Date: NL.: 05-1009 Supersedes

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MR O 910 is a form used for reporting certain financial information to the relevant authority.

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MR O 910 requires the reporting of specific financial data such as income, expenses, assets, and liabilities. The exact information to be reported may vary based on the regulations and guidelines.

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