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T PLEASE DO NOT ex: STAPLE THIS ARE AUJ it: ex: c:(o HEALTH INSURANCE CLAIM FORM PICA RTL 1. MEDICAID MEDICARE CAMPUS GROUP HEALTH PLAN (SSN or 10) CHAM PVA 2. PATIENT IS NAME (Last Name, First Name,
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rttlpica rtt a i stands for Report of Total Income, Profit and Credits Available.
Companies and individuals with taxable income are required to file rttlpica rtt a i.
You can fill out rttlpica rtt a i by providing accurate information about your income, profit, and credits available.
The purpose of rttlpica rtt a i is to report total income, profit, and credits available to the tax authorities.
You must report details of your income, profit, and any credits available for the tax year.
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