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Janet D. Larson, M.D., P.C. Maternal Fetal MedicineDate: Patient Name: I understand that my insurance may not cover the lab charges for the tests that my doctor has ordered on the above date. I understand

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How to fill out i understand that my

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5. Fill out the date and place where you are completing the form.
6. Read the statement 'I understand that my' and make sure you comprehend it fully.
7. If you genuinely understand and agree to the statement, carefully write 'I understand that my' below the statement.
8. Review the entire form to ensure all the sections are correctly filled out.
9. Sign and date the form to validate it.
10. Make copies for your records, if necessary.
11. Submit the form as instructed, whether it is by mail, online submission, or hand-delivery.
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