Appendix 2 Medicare Opt Out AgreementOut Agreement • October 28th, 2022
Contract Type FiledOctober 28th, 2022This contract is entered into, by and between Jan Hester MD PC (herein after called the “Physician”), whose principal medical office is located at 1120 E Elizabeth St, Building G, Suite 1 Fort Collins CO 80524 and (hereinafter called the “Beneficiary”), who resides at