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Get MEDICAL TRAVEL EXPENSE FORM - Maryland Workers

MEDICAL TRAVEL EXPENSE FORM Claim Number: You are entitled to reimbursement of medical travel expenses incurred because of your industrial injury. Complete the appropriate boxes below. Copies of supporting.

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  1. Open the form in the full-fledged online editing tool by clicking on Get form.
  2. Fill in the required boxes that are colored in yellow.
  3. Hit the arrow with the inscription Next to move from box to box.
  4. Use the e-autograph tool to add an electronic signature to the template.
  5. Put the date.
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  7. Click Done and download your new form.

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