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Get Have The Treating Physician Complete Section B Physician's Statement And Sign The Claim Form Or If

The treating physician complete Section B: Physician's Statement and sign the claim form or If hospitalized and/or confined to an intensive care unit/step-down unit, please send a copy of your hospital bill showing charges and the number of days you were confined. These items can be obtained directly from your healthcare provider(s) by requesting a UB04 (hospital bill) or HCFA1500 (non-hospital bill). If you are filing for disability, please complete the Initial Disability Claim Form (NY-S00224.

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