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Florida Television Care Service Record (This form to be maintained by the providers' office) SECTION I PROVIDER/PATIENT SECTIONMember Name: Member ID No.: Patient Name:SECTION II COVERAGE Sectional
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Florida Blue - Davis refers to a specific health insurance plan offered by Florida Blue that covers a range of medical services, often associated with the Davis Vision network for vision care.
Individuals enrolled in the Florida Blue - Davis health insurance plan or those responsible for filing on behalf of dependents are required to complete and submit the necessary paperwork.
To fill out the Florida Blue - Davis form, gather all required personal information, including policy number and dependent details, complete each section accurately, and submit it through the designated channels as instructed.
The purpose of Florida Blue - Davis is to provide members with access to affordable health care services, focusing on preventive care, vision care, and medical coverage.
Information that must be reported includes personal identification details, policy and plan information, dependent information, and any relevant medical history if required.
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