prior health insurance carrier / health insurance coverage / healthcare / health insurance / /
MedicalCondition
severe headaches / chronic indigestion / J. Any disease / rheumatism / allergies / Q. Any disease / I. Asthma / HIV / dementia / aneurysm / seizures / arthritis / kidney stones / Sickle Cell Anemia / B. Nephritis / cerebrovascular disease / E. Epilepsy / gout / injury / A. Diabetes / Multiple Sclerosis / disorder / Lyme Disease / diarrhea / D. Chest pain / Cystic Fibrosis / illness / persistent fever / S. Any disease / chronic conditions / Yes Illness / L. Alcoholism / tumor / paralysis / Alzheimer’s disease / cancer / mouth infections / disease / shortness of breath / emphysema / C. Any disease / stroke / sickness / leukemia hemophilia / chronic cough / emotional disorders / goiter / high blood pressure / depression / anemia / tuberculosis / /
MedicalTreatment
immunizations / counseling / surgery / /
Organization
U.S. government / Blue Cross and Blue Shield Association / Rhode Island Individual Sales Department / United States Department of Agriculture’s National Finance Center / Medicare / Social Security Administration / Peace Corps / Tribal / Indian Health Service / United States Department of Health and Human Services / / /
Position
care physician / Secretary / coordinator / Commissioner / treating physician / nurse care coordinator / /
Pre-existing Condition Insurance Plan for Rhode Island Application for Individuals Section 1 Instructions for Completing this Application 1. When filling out this application, type or print clearly in blue or black ink.