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Charles J. Lilly, MD, PC Michael J. Mutation, DO, LLC Carrie White, PAC2890 Health Parkway, Mt Pleasant, MI 48858 Phone: (989) 9534111 Fax: (989) 7736267 REFERRAL REQUEST Referring Provider:Date: Phone
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To fill out Lilly MD PC, follow these steps:
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Start by entering your personal information such as your name, address, and contact details.
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Provide your medical history, including any pre-existing conditions or allergies.
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Fill in the details of your primary care physician and any other healthcare providers you see regularly.
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Specify your insurance information, including the name of your insurance company and your policy number.
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Sign and date the form to certify that all the information provided is accurate and complete.
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Submit the filled-out Lilly MD PC form to your healthcare provider or the appropriate administrative office.

Who needs lilly md pc?

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Lilly MD PC is needed by individuals who are seeking medical care and treatment from Lilly Medical Department Primary Care (Lilly MD PC) or those who are required to provide their medical information to Lilly MD PC for insurance purposes or healthcare coordination.
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Lilly MD PC is a tax form used to report certain types of income, primarily related to specific professional services.
Individuals and businesses that receive income from specific professional services or other related sources are required to file Lilly MD PC.
To fill out Lilly MD PC, gather necessary income documents, follow the instructions on the form for each section, and ensure all income is accurately reported.
The purpose of Lilly MD PC is to provide a record of income from specific services to ensure proper tax reporting and compliance.
The information that must be reported includes total income received, types of services provided, and any applicable deductions.
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