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Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge. Farah Ashraf to discuss my medical status with the following person s. Witnessed by To remove a person s it must be submitted to this office in writing PATIENT TREATMENT WAIVER realize that I do not have the proper referral from my Primary Care Physician to cover the services that I am requesting from Premier Medical Group. Therefore I will be responsible for the payment of this visit and all...
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