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Reimbursement of Paid Medical Expenses Under 18 NYCRR
SUBJECT: Reimbursement of Paid Medical Expenses Under 18 NYCRR 360-7.5(a) Upon completion of the appropriate paper claim form, the provider must return the
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Certification of Health Care Provider for Employees
Either the employee or the employer may complete Section I. While use of this form is optional, this form asks the health care provider for the information
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HEALTH INSURANCE CLAIM FORM
PATIENTS OR AUTHORIZED PERSONS SIGNATURE I authorize the release of any medical or other information necessary to process this claim. I also request payment
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