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IC 24-5-13 5 Chapter 13 5 Buyback Vehicle - State of Indiana - seattleu

IC 24-5-13 5 Chapter 13 5 Buyback Vehicle - State of Indiana - seattleu 2025

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The document is a claim form from Summit America Insurance Services, L.C. for students to report accidents or illnesses. It requires personal information about the patient, details of the incident, and authorization for information release and payment to providers. The form emphasizes the importance of submitting claims to primary insurance first and includes fraud warnings specific to various states.

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