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Short Enrollment Request Form Name:Medicare Number:Home Phone Number:Date of Birth:Permanent Street Address (P.O. Box is not allowed): City:Apt. #: County:State:ZIP Code:Mailing Address (only if different
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Box is not allowed refers to a specific term or section that should not be used or included in a form or document.
Anyone filling out the form or document is required to ensure that box is not allowed is not used.
To fill out box is not allowed, simply leave the applicable box blank or make sure not to input any information that is considered not allowed.
The purpose of box is not allowed is to prevent the inclusion of certain information that may be incorrect, misleading, or prohibited.
No information should be reported in box is not allowed, it should remain empty or without any input.
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