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Date: CheckinTime: Summer: *Reminder:Pleasebringyourinsurance information, photoed, andmedicationlist 1301166:Layout 12/26/131:05 PM Page 1General Information Day Of Surgery the nearest emergency

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To fill out an in-network ambulatory surgical form, follow these steps:

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Anyone who is undergoing an in-network ambulatory surgical procedure and needs to file a claim with their insurance company may require an in-network ambulatory surgical form. This form is typically used by patients who have chosen a healthcare provider that is within their insurance network and need to provide details of the surgical procedure for claim processing purposes.

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