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DATE ENROLLED and/or LEGAL REPRESENTATIVE STREET ADDRESS CITY, STATE ZIP NOTICE OF ACTION Dear ENROLLED/LEGAL REPRESENTATIVE: MANAGED CARE PLAN has reviewed your request for SERVICE and AMOUNT, which
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Date enrollee andor legal refers to the date when an individual or legal entity was enrolled or legally registered.
Entities or individuals who are enrolled or legally registered must file date enrollee andor legal.
Date enrollee andor legal must be filled out by providing the exact date of enrollment or registration.
The purpose of date enrollee andor legal is to maintain accurate records of when individuals or entities were enrolled or legally registered.
The information reported on date enrollee andor legal includes the exact date of enrollment or registration.
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