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Get and Sign Air France  Form

Get and Sign Air France Form

Use a Air France template to make your document workflow more streamlined.

Service Item Requested Dates of Service Codes Requested Request Sent By Phone Total Pages Faxed SUD Inpatient and Outpatient U7833 Page 1 of 2 REQUIRED DOCUMENTATION SERVICE TYPE FOR SUD SUD Inpatient Outpatient continued Select applicable Chemical Dependency Residential Inpatient Chemical Dependency Admission Outpatient Chemical Dependency Units requested total group individual amounts Confirm and attach the following Rule 25 Assessment Rule 25 Summary or Comprehensive Assessment dated within...
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  3. Use the Cross or Check marks in the top toolbar to select your answers in the list boxes.
  4. Utilize the Circle icon for other Yes/No questions.
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  10. Check the Help section and contact our Support team if you run into any issues while using the editor.

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