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P4P Supplemental Information Fax Back Form PMP Name: Group: Address: TIN:Member RID:Phone:Member Name:DOB:Address: Product:HHWHIPHCCWe have evidence of the following services: Adolescent Well Care
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Value to form state refers to the amount or worth of assets, properties, or accounts that need to be reported to the state government for tax purposes.
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Individuals, businesses, estates, or organizations that meet certain criteria set by the state government are required to file value to form state.
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The purpose of value to form state is to provide the state government with an accurate representation of an individual or entity's assets, properties, or accounts for tax assessment.
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