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A. Do Pyle Vision Care Service Record (This form to be maintained by the providers' office) SECTION I PROVIDER PATIENT SECTION Member Name: Member ID No.: Patient Name: Member Plan Level: Hybrid Affinity
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The purpose of a Duie Pyle form is to report transportation and logistics information.
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Information such as shipment details, pick-up and delivery locations, and contact information may need to be reported on a Duie Pyle form.
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