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Flexible spending account / Itemized deduction / Income tax in the United States / Healthcare in the United States / United States / Health and welfare trust / Cafeteria plan / Taxation in the United States / Employment compensation / Healthcare in Canada


FLEXIBLE SPENDING ACCOUNTS CLAIM FORM P.O.Box 4381 Woodland Hills, Ca[removed]Customer Service Voice: [removed]Customer Service Fax: [removed][removed]
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City

Provider City / Woodland Hills / /

Company

SECTION B. DEPENDENT CARE INFORMATION / /

Currency

USD / /

Event

Product Recall / Product Issues / /

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IndustryTerm

household services / impaired insurance / transportation / dependent care services / car expenses / care equipment / transportation costs / Public transportation fares / oil / audio display equipment / transportation expenses / food / /

MedicalCondition

medical Learning disability / Alcoholism / /

MedicalTreatment

Photorefractive Keratectomy / Birth control / occupational therapy / Hypnosis / immunizations / Eye surgery / Vaccinations / Acupuncture / Teeth Physical therapy / Surgery / /

Organization

Internal Revenue Service / FSA / Medicare / /

Person

Psychiatric / /

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Position

therapist / maid / housekeeper / gardener / nurse / physician / handicap Chair / licensed practitioner Optometrist / medical necessity Psychologist / reclining chair / chauffeur / /

Product

Insulin Medication / nicotine / balance / insurance Therapy physical / co-payment / Deductibles / /

SocialTag