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We, (enter your name in the text box below), a Baptist Physician Partners' affiliated group (TIN), do hereby attest that a method/process is in place to measure and assess patient experience and feedback, as required by Baptist Physician Partners, LLC and Baptist Physician Partners, ACO, LLC.

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* 1. Group Name

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* 2. Taxpayer Identification Number (TIN)

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* 3. Submission by (Name, Title)

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