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H e an l t h A c c o u n t Services P.O. Box 942715 Sacramento, CA 94229 2715 (888) Callers (or 8882257377) TTY (877) 2497442 Fax (800) 9596545CMEMBER QUESTIONNAIRE for the Callers DISABLED DEPENDENT

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How to fill out h e a l

01

Start by writing down your personal information such as name, date of birth, and contact details.

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Proceed to fill out information about your medical history, current health conditions, and any medications you are currently taking.

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Finally, review the entire form for accuracy and completeness before submitting it to the healthcare provider.

Who needs h e a l?

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Individuals who are seeking medical treatment or consultation from a healthcare provider.

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Patients who are required to provide their medical history and personal information for registration purposes.

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Anyone who is accessing healthcare services and needs to fill out necessary paperwork for administrative purposes.

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What is h e a l?

HEAL stands for Health and Education Assistance Loan program.

Who is required to file h e a l?

Students in need of financial assistance for health and education expenses are required to file HEAL.

How to fill out h e a l?

To fill out HEAL, applicants need to provide personal and financial information on the application form.

What is the purpose of h e a l?

The purpose of HEAL is to provide financial assistance for health and education related expenses.

What information must be reported on h e a l?

Applicants must report personal information, financial details, and specific expenses they require assistance for on HEAL.

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