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All co-pays coinsurance deductible self-pay fees and past due patient balances are due at time of service. Michael A. Randolph M. D. P. C. 200 33rd Street Suite 136 Baltimore Maryland 21218 Telephone 410 554-6489 Fax 410 554-4498 Website www. By signing below the patient acknowledges receipt and understands the above-mentioned policies. Patient/ Guardian s Signature Date Revised 08/01/2016. Charge to patients or the patient s personal representative for copying of Medical Records The fee for...
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Randolph M is a form used for reporting financial information to the authorities.
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Individuals and organizations meeting certain criteria are required to file Randolph M. Specifically, those engaging in financial transactions above a certain threshold.
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