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Order Form(please print)Patient Name (First MI Last)Date of Birth Shipping Address* CityStatePreferred Phone NumberAlternate Phone NumberMember ID #Group #Catamaran Home Delivery for prescription
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What is box is typically required?
The box that is typically required is Box 1 on the form.
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Any individual or business may be required to file Box 1.
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The purpose of Box 1 is to report specific financial information.
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Box 1 typically requires reporting income or other financial data.
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