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DEPARTMENT OF THE ATTORNEY GENERAL Crime Prevention and Justice Assistance DivisionACCEPTANCE OF AWA SPECIAL CONDITIONS (for 103F Contracts)The undersigned Provider understands and agrees, on behalf
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Form undersigned provider understands is a document that needs to be filled out by healthcare providers.
Healthcare providers who have provided services to patients.
Form undersigned provider understands can be filled out manually or electronically, following the instructions provided by the relevant authority.
The purpose of form undersigned provider understands is to report the services provided by healthcare providers to patients.
Information such as the type of service provided, date of service, and patient information must be reported on form undersigned provider understands.
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