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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESMEDICAL DENTAL TELECOMMUNICATIONS PROVIDER AND MILLER APPLICATION/AGREEMENT (For electronic claim submission)1.0IDENTIFICATION

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Start by entering the date and the names of the parties involved in the agreement.

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This agreement is typically needed by parties entering into a legal contract or agreement. It is commonly used by individuals, businesses, organizations, or institutions that want to establish clear terms and obligations between two or more parties. Having a written agreement helps ensure that all parties involved understand and agree to their rights, responsibilities, and expectations.

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This agreement is between two parties engaged in a mutually beneficial relationship, typically outlining the terms and conditions governing their interaction.

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The agreement typically requires the names of the parties, dates, terms of the agreement, signature lines, and any relevant conditions or clauses.

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