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REIMBURSEMENT FORM 24 hour Tel: 80001151, Fax: +973 17382082 Please Complete Clearly (All Fields Mandatory) FORM No: ADMINISTRATIVE Healthcare Provider: Patients Name: Date of Service: Patients Tel:
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24 hour tel 80001151 is a telephone number designated for reporting incidents or emergencies within a 24-hour period.
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Individuals or organizations who are involved in incidents or emergencies that require reporting within 24 hours.
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The information to be reported on 24 hour tel 80001151 includes details about the incident or emergency, location, parties involved, and any relevant actions taken.
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