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PHYSICIAN AUTHORIZATION Name of Participant:___ ___ First LastParticipant Date of Birth___Name of Physician:___ FirstPhysician address:______ Last___ ___ Physician phone:___Physician email:___This
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First California Physician PartnersOrange is a healthcare provider network based in California.
Physicians and healthcare providers who are part of the First California Physician PartnersOrange network are required to file.
First California Physician PartnersOrange can be filled out electronically through their online portal or manually using the paper form provided.
The purpose of First California Physician PartnersOrange is to gather information about the healthcare providers in the network for reporting and regulatory purposes.
Information such as provider demographics, services provided, and patient volume must be reported on First California Physician PartnersOrange.
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