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Get and Sign Forms and ApplicationUniversity Health Center 2020-2022

Get and Sign Forms and ApplicationUniversity Health Center 2020-2022

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Uhs. uga.edu under About UHC Confidentiality Patient s Rights and Responsibilities. The UHC Pharmacy is contracted with many insurance plans for prescriptions whether written by UHC or non-UHC providers. Please check appropriate boxes below Medical HMO PPO POS Policyholder s name Insured is Self Parent/Responsible Party Other Third Party Dental Prescription Medical Insurance Company Name Insurance Company Street Address Telephone Number Policy Number Group Number PARENT/RESPONSIBLE PARTY/THIRD...
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