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Exhibit A AMIGA Health (AMIGA Health) on behalf of its covered affiliates Alexia Brothers Medical Center, St. Alexis Medical Center, Alexia Brothers Behavioral Health Hospital, and Alexia Brothers
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Amita Health is a healthcare provider network that offers medical services in the Chicago area.
Patients who have received medical services from Amita Health are required to file Amita Health forms.
Patients can fill out Amita Health forms online or in person at one of their healthcare facilities.
The purpose of Amita Health forms is to report medical services received and to ensure accurate billing.
Patients must report their personal information, medical services received, and insurance information on Amita Health forms.
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