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Employee Application Please Complete Entire Form in BLACK INK. 840 Carolina Street Sauk City WI 53583-1374 800 362-3309 Fax 608 643-2564 unityhealth. Original. A legible facsimile or electronic signature shall have the same force as the original. obtain medical records from health care providers who have treated me my spouse or any dependents applying for coverage under this application. If medical records are needed Unity will provide me with an authorization form. NOTICE OF SPECIAL...
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