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Name OA list of the names of Primary Care Providers (PCP's) in your Physician Organization (PO) columns HIGHLIGHTED IN YELLOWSection A: (Monthly Submittal) Please indicate the PCP's who agree to accept

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Start by writing your full legal name as it appears on your identification documents.

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Include any additional details such as apartment number, floor, or unit.

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State the postal or ZIP code associated with your address.

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What is current address information?

Current address information refers to the most recent residential or business address that an individual or entity uses for correspondence and official purposes.

Who is required to file current address information?

Individuals, businesses, and entities that are required to update their contact information with government agencies, financial institutions, or other relevant organizations must file current address information.

How to fill out current address information?

To fill out current address information, provide the complete street address, including apartment or unit number (if applicable), city, state, and ZIP code. Ensure that all details are accurate and up to date.

What is the purpose of current address information?

The purpose of current address information is to ensure reliable communication and accurate records regarding an individual or entity, facilitating adherence to legal and regulatory requirements.

What information must be reported on current address information?

The information that must be reported includes the full street address, city, state, ZIP code, and any relevant identifiers associated with the individual or entity (such as a Social Security number or business identification).

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