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This form should be used to
request continued authorization
of payment for
Day Program services
County of San Diego Mental Health Plan
CONTINUED Day Program Request
RECEIVED:
Fax/Mail to:
OptumHealth
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What is this form should be?
This form should be the annual tax return form.
Who is required to file this form should be?
Individuals and businesses with taxable income are required to file this form.
How to fill out this form should be?
This form should be filled out with accurate financial information for the tax year.
What is the purpose of this form should be?
The purpose of this form is to report income and calculate taxes owed.
What information must be reported on this form should be?
Income, deductions, credits, and tax liability must be reported on this form.
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