Signed by. <<title of officer responsible ) for administration of the contract>> ) for and on behalf of ) the Board of the Health Service Provider: )______________________________________ Witness' Signature )______________________________________ Witness' Full Name )______________________________________ Witness' Address )______________________________________ Witness' Occupation )______________________________________ Date )______________________________________ SCHEDULE 1: DETAILS
Appears in 9 contracts
Sources: Fee for Service Medical Services Agreement, Fee for Service Medical Services Agreement, Fee for Service Medical Services Agreement