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NOT TO BE USED FOR DJO BILLING PURPOSESDOCUMENTATION WORKSHEET: RETAIN IN PATIENT RECORD Page 1 of 2Doctor: ___ Fitter:___ Patient Name:___ Date:___EROS FORM II 626/627 Patient #:___ Additional Followup
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What is exos form ii 626?
Exos form ii 626 is a financial disclosure form required by the government.
Who is required to file exos form ii 626?
Individuals with certain financial interests or responsibilities are required to file exos form ii 626.
How to fill out exos form ii 626?
Exos form ii 626 can be filled out electronically or by hand, following the instructions provided by the issuing authority.
What is the purpose of exos form ii 626?
The purpose of exos form ii 626 is to disclose financial information to ensure transparency and prevent conflicts of interest.
What information must be reported on exos form ii 626?
Information about assets, income, liabilities, and other financial interests must be reported on exos form ii 626.
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