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Get and Sign Adnic Reimbursement Form
__________________
PAYER ________________________________________
DATE
NAME
______________________________________________
______________________________
Signature and Stamp:
I hereby certify having received prescribed treatment and allow NAS authorized personnel to obtain any
requisite medical details from my current and previous physicians and/or case files.
BENEFICIARYS’ SIGNATURE
__________________________________
NAS Administration Services , P.O Box 44505 Abu Dhabi , UAE
Tel :...
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