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Get and Sign Interglobal Claim Form 2018-2022
Therapist, unless the claim is for a repeat prescription for medication to treat a chronic medical condition and we have
previously approved and paid claims for the same medication to treat the same chronic medical condition.
Further information about how to complete this form can be found in the Claims procedures.
Your claim will be processed by Aetna Global Benefits (UK) Limited on behalf of the insurer. Failure to complete
all sections of this form may result in delays.
Section A: Patient...
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