Aps 5320 group form: Fill out & sign online

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Click ‘Get Form’ to open the aps 5320 group form in the editor.
Begin with Section 1, where you will provide your personal information. Fill in your first name, middle name, last name, birth date, employer name, and claim number. Ensure that you authorize your physician to share medical information by signing at the bottom.
In Section 2, your physician will need to complete the health information about your condition. They should provide treatment dates, diagnosis codes, and any relevant clinical findings. Make sure they include their signature and contact details in Section 3.
Before submitting, ensure that all pages are labeled with your name and claim number to avoid delays. You can then fax or mail the completed form as instructed in Section 4.

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Versions	Form popularity	Fillable & printable
2015	4.9 Satisfied (38 Votes)
2013	4 Satisfied (42 Votes)

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