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Provider Name: Member Name: Provider ID: DOB: Member ID#: Question Y N NA Examples of Evidence Qualifications A. Comprehensiveness of Record1. Is there a signed Informed Consent in the treatment record?
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Provider name member name refers to the name of the healthcare provider or member involved in a particular transaction.
The healthcare provider and the member are both required to provide their respective names for filing.
The provider and member can fill out their names on the designated fields in the transaction form.
The purpose of providing the names of the provider and member is to accurately identify the parties involved in the transaction.
The names of the healthcare provider and member must be reported accurately.
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