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Fixed Percentage Option Election - Franco Signor

Fixed Percentage Option Election - Franco Signor 2025

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The document is a notification to MSPRC regarding a liability insurance settlement where the sender opts for a fixed payment option to repay Medicare. The sender confirms receipt of a settlement, specifies the payment amount as 25% of the total settlement, and certifies that they have not received other related bills from Medicare. It includes personal details such as beneficiary name, Medicare number, and injury description, along with instructions for payment submission.

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