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Reset From John C. Hersey, OD Virginia L. Gilmore, OD www.HerseyEyeCare.com Authorization to Release Health Care Information Patient Name: D.O.B: Hereby Authorizes: To disclose my health care information
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What is form - health care?
Form - health care is a document used to report information about an individual's health care coverage.
Who is required to file form - health care?
Employers with 50 or more full-time employees must file Form - health care.
How to fill out form - health care?
Form - health care can be filled out online or by mail using the instructions provided by the IRS.
What is the purpose of form - health care?
The purpose of Form - health care is to provide information to the IRS about an individual's health care coverage.
What information must be reported on form - health care?
Form - health care requires information about the individual's health care coverage, including the type of coverage and the period it was in effect.
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