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Fnha medical transportation form

Health benefits medical transportation request form - First Nations 2025

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The document is a Medical Transportation Request Form designed for clients seeking health benefits related to transportation for medical appointments. It includes sections for client and escort information, health practitioner details, travel information, accommodation needs, and authorization for the release of relevant records. The form requires completion with personal details, appointment specifics, and necessary signatures, along with instructions for submitting receipts and additional documentation.

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