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MIMIC Insurance CompanyProfessional Entity Application Instructions
and
Eligibility Requirements
PLEA SE READ CAREFULLY.
Your policy will not provide separate limits of coverage to your entity for
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This document is an entity application form.
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Healthcare entities are required to file this form.
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The purpose of this form is to update information about healthcare entities.
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Information such as entity details, contact information, and any changes to the entity must be reported on the form.
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