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Fax completed form to: 18556337673 Questions, please call: 18553440930 24 hours a day, 7 days a week TTY users call: 18662361069 Important Information about Prescription Drug Coverage To: From: Fax:
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How to fill out a fax completed form:

01
Begin by reviewing the form and ensuring that all required fields are clearly marked.
02
Start by entering your personal information, such as your name, address, and contact information, in the designated sections.
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Next, provide any additional details that the form requires, such as your job title, company name, or account number.
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Carefully read any instructions or guidelines provided alongside the form and follow them accordingly. This may include attaching supporting documents, filling out specific sections, or providing signatures.
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Double-check all the information you have entered to ensure accuracy and completeness. Mistakes or missing information can delay the processing of your form.
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Once you are satisfied with your form, prepare it for faxing. Ensure that the document is legible, and remove any staples or paper clips that may interfere with the scanning process.
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Dial the fax number provided by the recipient, ensuring that you accurately enter each digit.
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Place the form into the fax machine's feed tray and initiate the sending process. Some fax machines may require additional steps, such as entering a cover sheet or confirmation page, so be sure to follow the specific instructions for your machine.
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After successfully transmitting the form, wait for a confirmation message or receipt to ensure that it was received by the intended recipient.
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Keep a copy of the completed form for your records.

Who needs a fax completed form:

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Companies or organizations that require paper copies of documents for their records.
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Government agencies that still rely on fax as an accepted method of communication.
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Healthcare providers who need to send important medical information or prescriptions to pharmacies or specialists.
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Legal professionals who need to send or receive signed documents, such as contracts or court filings.
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Financial institutions that require the submission of forms, such as loan applications or account updates.
In summary, anyone who needs to exchange official documents or information in a secure and efficient manner may require a fax completed form. It is important to follow the provided instructions and ensure that all required fields are accurately filled out before transmitting the form.
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