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Extended Health Care Claim Form Use this form for all medical expenses and services. For dental expenses, please use the Dental Claim Form. Please print clearly and be sure all sections are complete

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What is extended care application form?

The extended care application form is a document used to apply for extended care services, such as long-term care or home health care.

Who is required to file extended care application form?

Any individual who wishes to receive extended care services must file an extended care application form.

How to fill out extended care application form?

To fill out the extended care application form, you need to provide personal information, medical history, financial details, and any other relevant information as requested on the form.

What is the purpose of extended care application form?

The purpose of the extended care application form is to gather necessary information about the applicant to determine their eligibility for extended care services.

What information must be reported on extended care application form?

The extended care application form typically requires information about the applicant's personal details, medical history, financial status, and any supporting documentation.

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