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AUTHORIZATION AND RELEASE OF APPLICANT - Tpqvo

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The document is an application form for health care organization privileges through the Tennessee Physicians' Quality Verification Organization (TPQVO). It outlines the necessary steps and required documents for applicants seeking membership in a medical staff or network, including fees, identification, licenses, insurance information, and professional history. The application also includes sections for personal information, education, practice history, and consent for background checks. Additionally, it emphasizes the importance of providing accurate information and the consequences of misrepresentation.

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