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REPAYMENT APPLICATIONElectrical Industry Insurance Benefit Trust Fund of Alberta #200, 4224 93 Street, Edmonton, Alberta, T6E 5P5 Telephone: (780) 4652882 Toll Free: 18002683649 Fax (780) 4650808
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Individuals who are self-paying for services or products and need a receipt for proof of payment.

What is NEW Self Pay PAD App.DOCX. NEW Self Pay PAD Appv1 Form?

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NEW Self Pay PAD App.DOCX. NEW Self Pay PAD Appv1 template instructions

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The new self pay pad is a form used to report self-pay patients in a healthcare setting.
Healthcare providers are required to file the new self pay pad.
The new self pay pad can be filled out electronically or manually, with information regarding self-pay patients.
The purpose of the new self pay pad is to accurately document self-pay patients for reporting and tracking purposes.
Information such as patient name, services rendered, and payment details must be reported on the new self pay pad.
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