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BIW as of 1/15/14 I attest that the above information is correct and true to the best of my ability. In this event we will mail you a statement and appreciate your prompt payment. If an overpayment from you is discovered you will be refunded once all claims for all dates of service are processed. There is a 5. Therefore unless you alert us prior to treatment you will be financially responsible for noncovered expenses. Or ounces etc. Frequency Daily 2 X day etc. Route of Administration Orally...
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To fill out name first, follow these steps:
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Name first refers to filling out the first name of an individual or entity.
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The purpose of name first is to accurately identify an individual or entity by their first name.
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The information reported on name first typically includes the first name of the individual or entity.
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