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KENDRICK SPENCE, M.D., P.A. CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION Patient signature: PRINTED NAME: In connection with the medical services that I am receiving from Dr. Kendrick Spence,
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Kenrick Spence MD PA is a medical practice or healthcare organization led by Dr. Kenrick Spence.
Dr. Kenrick Spence or the designated authorized person responsible for the financial reporting of the medical practice is required to file Kenrick Spence MD PA.
To fill out Kenrick Spence MD PA, the designated authorized person must gather all financial information, comply with reporting guidelines, and submit the form by the deadline.
The purpose of Kenrick Spence MD PA is to accurately report the financial status and activities of the medical practice for regulatory, compliance, and transparency purposes.
Information such as revenue, expenses, assets, liabilities, and other financial data related to the medical practice must be reported on Kenrick Spence MD PA.
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