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dd form 2642
dd form 2642

Fillable DD Form 2642 - Military.com

Description

- PATIENT'S COPY CHAMPUS CLAIM PATIENT'S REQUEST FOR MEDICAL PAYMENT Form Approved OMB No. 0720-0006 Expires Sep 30, 2002 The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information....
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