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I acknowledge the fact of these risks and I am willing to assume responsibility while participating in intercollegiate athletics at Muskegon Community College. Policy Is this plan an HMO or PPO yes no Is pre-authorization required for treatment Is a 2nd opinion required before surgery AUTHORIZATION TO PERMIT USE AND DISCLOSURE OF HEALTH INFORMATION This Authorization was prepared by First Agency Inc. for purposes of obtaining information necessary to process a claim for benefits. I also...
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How to fill out name birth datemale female
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To fill out the name, write your first name followed by your last name.
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To fill out the birth date, write the day, month, and year of your birth.
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To indicate gender, choose either male or female.
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Anyone who is required to provide personal information for identification purposes needs to fill out name, birth date, gender.
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What is name birth datemale female?
Name birth date refers to the legal name and date of birth of an individual, whether male or female.
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