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Pharmacology / Copayment / Explanation of benefits / Medical prescription / Flexible spending account / Pharmaceutical sciences / Co-Pay Cards / Employment compensation / Medicine / Health


Microsoft Word - RRF - copay - July[removed]doc
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Document Date: 2012-07-23 12:06:15

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File Size: 32,07 KB

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City

Patient / /

Facility

Clinic Hospital / /

IndustryTerm

bank statement / insurance status / /

Organization

Clinic Hospital / Patient/Guardian Pharmacy Physician’s Office / /

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Position

COPAYMENT REQUEST Patient/Guardian/Pharmacy/Physician / /

SocialTag