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MEDICAL CERTIFICATES CLAIM FORM MC155 (Rev.6/13) This form must be completed and enclosed with all books of counterfoils returned for payment. Please return to Medical Review & Assessment Section,
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What is medical certificates claim form?
Medical certificates claim form is a document used to file a claim for medical expenses or benefits.
Who is required to file medical certificates claim form?
Anyone who needs to claim medical expenses or benefits.
How to fill out medical certificates claim form?
To fill out the medical certificates claim form, you need to provide personal information, details of medical expenses, and any supporting medical documents.
What is the purpose of medical certificates claim form?
The purpose of the medical certificates claim form is to request reimbursement for eligible medical expenses or to claim relevant benefits.
What information must be reported on medical certificates claim form?
The information that must be reported on the medical certificates claim form includes the claimant's personal details, medical provider's information, description of medical services or expenses, and any other required supporting documentation.
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