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Exhibit A5 LIBERTY Dental Plan of Florida, Inc. Provider Agreement Adult Medicaid Fee for Service Programs Addendum General Dentist and Specialist This Adult Medicaid Fee for Service Programs Addendum
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How to fill out the addendum to exhibit a-2:

01
Start by obtaining the addendum form for exhibit a-2. This can usually be found on the official website of the organization or institution that requires it.
02
Read the instructions provided on the form carefully. Familiarize yourself with the purpose and specific requirements of the addendum.
03
Fill in your personal information, such as your name, contact details, and any other identifying information requested on the form.
04
Clearly state the purpose of the addendum in the designated section. This could include providing additional information, correcting errors, or making amendments to the original exhibit a-2 document.
05
Include any necessary attachments or supporting documents that are required to accompany the addendum. Ensure that these documents are labeled correctly and organized in a logical order.
06
Review the addendum form once again to ensure that all fields have been completed accurately and all necessary information has been provided.
07
Sign and date the form in the appropriate spaces, indicating your agreement to the contents of the addendum.
08
Make copies of the completed addendum for your records before submitting it.

Who needs the addendum to exhibit a-2:

01
Individuals or organizations who need to amend or supplement the information provided in exhibit a-2 may require the addendum.
02
This could include parties involved in legal proceedings, contractual agreements, or any situation where a modification or clarification to the original exhibit a-2 is necessary.
03
It is recommended to consult the specific guidelines or requirements of the relevant institution or body to determine if the addendum is required.
Remember, it is important to follow any specific instructions or guidelines provided by the organization or institution requesting the addendum to ensure compliance with their requirements.
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An addendum to exhibit a-2 is a supplementary document that provides additional information or clarifications to the original exhibit A-2.
The party responsible for preparing the original exhibit A-2 is typically required to file the addendum.
The addendum should be filled out with additional information or clarifications as needed, following the format of the original exhibit A-2.
The purpose of the addendum is to provide supplementary information or clarifications to ensure a complete and accurate record.
Any additional information or clarifications relevant to the original exhibit A-2 must be reported on the addendum.
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