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Get AU DB2-AH 2007

E by placing an X in the box provided. O R P H T L A HE 3. A Card with VISITOR RHCA indicates Medicare will only pay benefits for IMMEDIATELY NECESSARY MEDICAL CARE. 4. When completing the voucher use the following steps: (a) Remove this cover sheet (b) Complete the relevant sections of the forms making sure information entered into a box is completely within the box. EXAMPLE OR OR D E I L AL 1 2 3 4 5 1 2 / 0 2 / 0 7 X 5. Patient MUST sign the form AFTER the form has been completed. 6. S.

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