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Get FL Azalea Health Form 10 Packet 2013-2024

Who are eligible to participate in the sliding fee scale program. Eligible patients will also qualify for reduced cost prescriptions. To determine your eligibility for this federally funded program, verification of your income is required. You must update this information at least annually to continue your participation in the program. This information is only used to calculate your discount and is kept confidential. Patient Name Date: I would li.

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