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Get DD Form 2527, Statement Of Personal Injury - Possible Third Party Liability, 20150911 Draft

O, treatment, payment, and healthcare operations. DISCLOSURE: Voluntary. However, your failure to provide information may result in a claims processing delay and/or the denial of claims. N E E D S D D 6 7 INSTRUCTIONS We recently received a claim from you or your medical care provider for medical services required by (you/your family member) that indicate that the patient may have had an illness or injury related to an accident. Payment of your claims has been suspended until we receive more.

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