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PLEASE COPY AND PASTE THE ENTIRE FORM BELOW ONTO COMPANY LETTERHEAD PRIOR TO SENDING. PROOF OF REPRESENTATION Type of Medicare Beneficiary Representative (Check one below and then print the requested
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The 'please copy and paste' refers to copying and pasting a specific piece of information.
Anyone who is instructed to do so by a specific authority or organization.
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The purpose of 'please copy and paste' is to ensure accurate and efficient transfer of information.
The specific information required to be copied and pasted will be specified by the authority or organization requesting it.
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