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Check List

MEDICAL INSURANCE CHECK LIST

Have I enclosed a prescription or letter of medical necessity or at an absolute minimum a Prescription?

YES  OR    NO

Have I completed and SIGNED the Medical Benefits Assignment Sheet

YES  OR    NO

Have I completed the Medical Patient/Physician/Insurance Information Sheet?

YES  OR    NO

Have I Filled in the Patient Order Form

YES  OR    NO

 

 
Insurance Info Form
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Check List
Before you fax us, or send in a claim or mail us a claim, please be sure that everything we need is in the package.

 
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