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Ocfs Ldss 4433 Form PDF

Ocfs Ldss 4433 Form PDF

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[Music] this video will guide you on how to complete the medical claims authorization single form using pdf e-signature do take note that the particulars used during this video is just an example let's begin first open up the medical claims authorization single form using adobe acrobat reader on the right side select fill and sign you may use the tools above to fill up the form under section a please provide patients particulars you may adjust the size of the tools do note that the gray area is only for patient who wants to use their family member's medisave as an additional payer moving on to fill up section c you will need to circle yes or nowhere applicable fill up this segment to authorize the deduction of medisave for inpatient stay day surgery or inpatient treatment period and indicate the admission date on the right side whereas for outpatient visits circle yes for all outpatient treatments under segment a select the medisave schemes that you are authorizing for for medisave sch

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