John Williams

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Dependents Added

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Spouse

Jane Walles

Social Security Number

617-24-5636

Gender

Female

Date of Birth

28/12/1995

Addresss

Same as Empoyee

Child 1

Christian Walles

Social Security Number

65-24-5736

Gender

Male

Date of Birth

28/12/2015

Addresss

Same as Empoyee

Medical Plan

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Anthem Medical HMO Plan Name

Member	Enrolled	PCP	PCP ID	Existing Patient	City	State	Zip
John Williams	Enrolled	Adan Clark	6184770	Yes	Los Angeles	California	90064
Gregory Williams	Enrolled	Adan Clark	6184770	Yes	Los Angeles	California	90064
Hunter Williams	Enrolled	Mathew Rid	2104560	No	Los Angeles	California	90064

Dental Plan

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Dental HMO Plan Name

Member	Enrolled	PDO	PDO #	Existing Patient	City	State	Zip
John Williams	Enrolled	Office Name	6184770	Yes	Los Angeles	California	90064
Gregory Williams	Enrolled	Office Name	6184770	Yes	Los Angeles	California	90064
Hunter Williams	Waived

Vision Plan

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Vision HMO Plan Name

Member	PDO	PDO #	Existing Patient	City	State	Zip	Enrolled
John Williams
Gregory Williams
Hunter Williams

Life Plan

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Life HMO Plan Name

Member	PDO	PDO #	Existing Patient	City	State	Zip	Enrolled
John Williams
Gregory Williams
Hunter Williams