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INSTRUCTIONS THE STATEMENT OF HEALTH FORM AND THE AUTHORIZATION FORM THAT FOLLOW THIS SECTION INSTRUCTIONS TO THE SCOREKEEPER (The Record keeper may be the Group Customer, a Third Party Administrator
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A separate statement of is a document that provides specific information apart from the main report or form.
Individuals or entities who have additional information to report that does not fit on the main form may be required to file a separate statement of.
To fill out a separate statement of, one must follow the instructions provided on the form and accurately report the required information.
The purpose of a separate statement of is to ensure that all relevant information is disclosed, even if it cannot be included on the main form.
The specific information that must be reported on a separate statement of will depend on the requirements of the form or report to which it relates.
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