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Form B1: EVALUATION FORM Physical
INSTRUCTIONS: This form is to be completed by the clinician. For additional clarification and examples, see UDS Coding. Guidebook for Follow-up Visit Packet,
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Schedule B-1 (Form 1065) (Rev. August 2019)
Use Schedule B-1 (Form 1065) to provide the information applicable to certain entities, individuals, and estates that own, directly or indirectly, an interest
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