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Al facilities are limited or nonexistent? B. IF "YES", THE MEMBER (and family members, if applicable) MUST BE SCHEDULED FOR A FOLLOW-UP EVALUATION OF MEDICAL STATUS WITHIN 30 CALENDAR DAYS OF THE ANTICIPATED DATE OF LOSS (Item 9). INDICATE DATE, TIME AND LOCATION OF APPOINTMENT(S) 22. Medical Records Indicate the Member Requires the Following (Check those appropriate) REQUIRES HAS MISSING ITEM A. Two pairs of spectacles B. Protective mask spectacle insert C. Two hearing aids D. Medi.

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