| Document Date: 2013-01-08 18:56:47
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Company SPEECH THERAPY KPGP MEMBER PAYS Limited / / Currency USD / / Facility HOSPICE SERVICES / / IndustryTerm cosmetic services / durable medical equipment / travel immunizations / laboratory services / dental care services / facility services / transportation / basic laboratory services / investigational services / non-hospital residential services / custodial and intermediate level nursing facility services / ambulance services / homemaker services / / MedicalCondition genetic disease / voluntary infertility / sexual dysfunction / / MedicalTreatment RADIATION THERAPY / chiropractic / radial keratotomy / acupuncture / surgery / immunizations / IN VITRO FERTILIZATION / / Organization FDA / / Position Physician / homemaker / / ProvinceOrState Connecticut / / Technology RADIATION / ultrasound / MRI / /
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IDENTIFYING NAME OF PLAN: _______________________________________________[removed]Form HC-7(b)