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 Doh 4359 2010-2023

Doh 4359 2010-2023

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EXPLAIN: General Information PHYSICIAN NAME LICENSE # ADDRESS: STREET TELEPHONE NO. ( ) CITY STATE If the examination was conducted by a Physician’s Assistant, Specialist’s Assistant, or Nurse Practitioner, Identify: Name Profession: ZIP CODE License # PLACE OF EXAMINATION: DATE OF EXAMINATION: 3. Medical Findings NOTE: Indicate N/A if an item does not apply to this patient or Unk if the requested information is unknown to the physician signing this form. Height: Weight: For the...
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in our demo today we'll be going through an application for a family a single mom Josephine and her son Marvin both of them are looking to pay for health care coverage at this point in our scenario Josephine has created an account and has been identity proofed in account holders I did our identity proof so that the marketplace can protect a consumers personal information and privacy on this first page of the application we enter in basic information about the family we ask consumers to include themselves their spouse any children they are taken care of and anyone they will include on their federal tax return Josephine's information was pre-populated from the account creation process she enters an information about Marvin when filling out the application it's important to click on the blue box at the top of the screen if you want the marketplace to see if you qualify for federal financial assistance on the first set of screens we asked for demographic information about each person on th

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