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By checking this box I certify that applying the 72 hour standard review time frame may seriously jeopardize the life or health of the Customer or the Customer s ability to regain maximum function Provider Signature Date All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including Cigna Health and Life Insurance Company Cigna HealthCare of South Carolina Inc. Cigna HealthCare of North Carolina Inc. Cigna HealthCare of Georgia...

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