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PCAT-3183 Free of Care Form docx

PCAT-3183 Free of Care Form docx-2025

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The document is a 'Free of Care Form' from Medical Mutual, which is used to finalize claims by determining if a patient's condition has been previously treated. It requests specific patient information and requires confirmation of prior treatment for the reported condition. The completed form must be sent to Medical Mutual within ten days.

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