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Folsom Obstetrics & Gynecology Statement of Financial Responsibility/ Assignment of Benefits I acknowledge that I am legally responsible for all charges in connection with the medical care and treatment
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Include any specific financial targets or goals that need to be achieved.
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Financial responsibility and assignment refers to the obligation of an individual or entity to demonstrate their ability to meet their financial obligations.
Individuals or entities who are involved in certain activities such as driving a vehicle or operating a business may be required to file a financial responsibility and assignment.
To fill out a financial responsibility and assignment form, individuals or entities must provide information about their financial assets, liabilities, and sources of income.
The purpose of financial responsibility and assignment is to ensure that individuals or entities are financially capable of meeting their obligations.
Information such as assets, liabilities, income sources, and financial obligations must be reported on a financial responsibility and assignment form.
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