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Medical Claim Reinsured and/or Administered by Connecticut General Life Insurance Company Cagney Health and Life Insurance Company Cagney Behavioral Health, Inc. Cagney Healthcare×This form can be

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What is its not intended for?

Its not intended for purposes other than the specified usage.

Who is required to file its not intended for?

Individuals or entities who have been explicitly instructed not to use it for certain purposes.

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Ensure that the form is left blank or marked as not applicable for the intended purpose.

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To clearly communicate that the form is not to be used for specific activities or reasons.

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Any details or data that do not align with the specified intended purpose.