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Cagney Dental Oral Health Integration Program Reimbursement Form
INSTRUCTIONS: Complete sections AG.
Checklist of items required for reimbursement:Mail completed form and attachments to:Completed
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How to fill out instructions complete sections a-g
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To fill out instructions and complete sections a-g, follow these steps:
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a) Begin by reading the instructions carefully to understand the requirements.
03
b) Gather all the necessary information and documents needed to complete the sections.
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c) Start with section 'a' and enter the requested information accurately.
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d) Move on to section 'b' and provide the relevant details as instructed.
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e) Proceed to section 'c' and fill in all the required information.
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f) Continue with sections 'd', 'e', 'f', and 'g', providing the necessary details at each step.
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g) Once you have completed all the sections, review your work for any errors or omissions.
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h) Finally, sign and date the instructions if required and submit it as per the given guidelines.
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