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SHIIP Client Information Form

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The SHIIP Client Information Form is designed to collect essential personal and Medicare-related information from clients, including their name, address, Medicare claim number, effective dates for Parts A and B, representative details, demographics, income and asset levels, drug coverage preferences, and how they learned about SHIIP. It also includes sections for clients needing a Medicare Part D comparison and information on current benefits.

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Versions	Form popularity	Fillable & printable
2020	4 Satisfied (28 Votes)
2019	4.3 Satisfied (46 Votes)

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