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PATIENT REGISTRATION ID:Chart ID:First Name:Patient Is:Last Name:policyholder 1 Responsible PartyMiddle Initial:Preferred Name:Last Name:First Name:Middle Initial:Address 2:Address:City, State, Zip:Pager: Work
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1 responsible party refers to a person or entity that has a significant level of control or ownership in a company or organization.
The person or entity that meets the criteria of a responsible party is required to file.
To fill out 1 responsible party, you will need to provide detailed information about the individual or entity, including their name, contact information, and level of control or ownership.
The purpose of identifying a responsible party is to increase transparency and accountability within an organization.
The information to be reported on a responsible party includes their full name, address, social security number or EIN, and the percentage of ownership or control.
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