Sample - Md Practice 20 rx initial order form
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Sample Md practice 20 rx initial order form
Transcript of Sample - Md Practice 20 rx initial order form
![Page 1: Sample - Md Practice 20 rx initial order form](https://reader038.fdocuments.us/reader038/viewer/2022100600/5563b7b0d8b42ad83c8b4aa9/html5/thumbnails/1.jpg)
FEE / FORMULATION APPROX COST
# SUBTOTAL
APPROX TOTAL:
XI approve this order
XI approve the implimentation fee
XI approve the private insurance setup fee