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For Medicare beneficiaries I/we have provided all necessary information for proper assignment of Medicare benefits. MRN GENERAL CONSENT TO TREAT/ PATIENT AUTHORIZATION/ACKNOWLEDGEMENT OF BENEFITS RELEASE The following are the conditions for services provided by the Vidant Medical Group which is affiliated with Vidant Health Inc. for the patient whose name appears at the bottom of this page. ACKNOWLEDGEMENT OF RECIEPT OF NOTICE OF PRIVACY PRACTICES I/we have received a copy of the Notice of...
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