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NEIGHBORHOOD HEALTH PLAN ERA CONTRACT INSTRUCTIONS (04293) FAX or EMAIL the completed and signed authorization letter to: MD On-Line ATTN: Enrollment 888-837-2232 setup mdol.com THIS LETTER MUST BE
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This letter must be a formal document requesting specific information or action.
The party identified in the instructions or regulations is required to file this letter.
The letter must be filled out completely and accurately following the instructions provided.
The purpose of this letter must be to communicate important information or request a specific action.
The information that must be reported on this letter will depend on the specific requirements outlined in the instructions.
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