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Get Scope Cover Sheet Form

To ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential and should be completed by each person with Medicare or his/her authorized representative. Please initial below beside the type of product(s) you want the agent to discuss. Stand-alone Medicare Prescription Drug Plans (Part D) Medicare Prescription Drug Plan (PDP) A stand-alone drug plan that adds prescr.

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