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Statement of December 31, 20 Company Names: Report #2 Statement of Revenue, Expenses and Net Worth ***POS ONLY*** 2 3 Areolate Uncovered XXX Member Months Revenues: 1. 2. 3. 4. Premium (Net of $0
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The purpose of point of service form-1xls is to track and report services provided.
Information such as date of service, type of service, and provider information must be reported on point of service form-1xls.
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