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FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Check this box if no longer subject to STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Section 16. Form 4

How to fill out form 4 - viveve

How to fill out form 4 - Viveve:

1. Begin by downloading the form from the official Viveve website or obtaining a physical copy from a healthcare provider.
2. Start by filling out your personal details, including your full name, date of birth, address, and contact information. Make sure all the information is accurate and up-to-date.
3. Next, provide your healthcare provider's details, including their name, address, and contact information. This should be the healthcare professional who is recommending or performing the Viveve procedure.
4. In the "Medical History" section, answer the questions truthfully and to the best of your knowledge. This section typically asks about previous medical conditions, surgeries, medications, allergies, and any other relevant health information.
5. Move on to the "Consent" section, where you will acknowledge that you understand the risks and benefits associated with the Viveve procedure. Read this section carefully and sign it to indicate your informed consent.
6. If applicable, provide details about any insurance coverage you have. This may include policy numbers, insurance company names, and other relevant information. If you do not have insurance coverage, leave this section blank.
7. Review the completed form to ensure all the information is accurate and complete. Double-check for any missing or inconsistent details.
8. Once you have thoroughly reviewed the form, sign and date it at the designated space to certify that the information provided is true and accurate to the best of your knowledge.

Who needs form 4 - Viveve:

1. Patients seeking the Viveve procedure: Form 4 - Viveve is typically required to be filled out by patients who are undergoing or considering the Viveve procedure. This form ensures that the healthcare provider has all the necessary information about the patient's medical history, consent, and insurance coverage (if applicable).
2. Healthcare professionals performing or recommending the Viveve procedure: Form 4 - Viveve also serves as a record for healthcare professionals involved in the Viveve procedure. It helps them assess the patient's eligibility for the procedure, understand their medical history, and obtain informed consent for the treatment.
3. Insurance companies and billing departments: Form 4 - Viveve may be used by insurance companies or billing departments to process claims and verify the eligibility of the procedure for insurance coverage. The form helps ensure that all necessary medical and consent information is provided for proper reimbursement and documentation purposes.

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What is form 4 - viveve?

Form 4 - viveve is a disclosure form required by the Securities and Exchange Commission (SEC) for reporting insider transactions.

Who is required to file form 4 - viveve?

Company insiders, such as executives, directors, and beneficial owners of more than 10% of a company's stock, are required to file form 4 - viveve.

How to fill out form 4 - viveve?

Form 4 - viveve can be filled out electronically through the SEC's EDGAR system. The form requires the insider to disclose details of their transactions in the company's stock.

What is the purpose of form 4 - viveve?

The purpose of form 4 - viveve is to provide transparency to investors and the public regarding insider transactions in a company's stock.

What information must be reported on form 4 - viveve?

Form 4 - viveve requires information such as the insider's name, relationship to the company, details of the transaction (date, amount, price), and any options or other securities involved.