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Get SCHOOL INSURANCE CLAIM FORM - The School District Of Palm ... - Palmbeachschools

Important note Please do not leave the claim form with the Hospital or Doctor s Office. 3 Mail this form copies of all itemized bills and copies of the primary EOB s directly to School Insurance of Florida P. Signature of School Official ATTENDING PHYSICIAN OR DENTIST STATEMENT ON REVERSE SIDE. DO NOT LEAVE THIS FORM WITH YOUR PHYSICIAN OR HOSPITAL. PLEASE MAIL THIS FORM DIRECTLY TO SCHOOL INSURANCE OF FLORIDA IN ORDER TO ESTABLISH A CLAIM. Howev.

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