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DISTRICT COUNCIL 37 HEALTH AND SECURITY PLAN 125 BARCLAY STREET, NEW YORK, N.Y. 100072179 (212) 8151234 PRE AUTHORIZATION CLAIM FOR COMPLETED SERVICESMEMBER INFORMATION: Member SSN/PID:Gender:Last/First
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How to fill out dc 37 dental form
How to fill out dc 37 dental form
01
Obtain a copy of the DC 37 dental form from the appropriate source.
02
Fill out the patient's personal information such as name, address, date of birth, and contact information.
03
Provide details of the dental treatment being requested, including the name of the dentist or dental facility, the date of treatment, and the reason for the treatment.
04
Include any additional information or documentation required by the form, such as insurance information or previous dental history.
05
Review the completed form for accuracy and completeness before submitting it to the appropriate party.
Who needs dc 37 dental form?
01
Anyone who is a member of DC 37 union and requires dental treatment may need to fill out the DC 37 dental form.
02
Individuals seeking reimbursement for dental treatment expenses through DC 37 dental benefits may also need to fill out this form.
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What is dc 37 dental form?
The DC 37 Dental Form is a document required for members of the DC 37 union to enroll or update their dental coverage.
Who is required to file dc 37 dental form?
All members of the DC 37 union wishing to enroll, change, or update their dental benefits are required to file the DC 37 Dental Form.
How to fill out dc 37 dental form?
To fill out the DC 37 Dental Form, members need to provide personal information, including their name, address, membership number, and details about dependents, along with selecting their preferred dental coverage.
What is the purpose of dc 37 dental form?
The purpose of the DC 37 Dental Form is to facilitate the enrollment and management of dental benefits for union members.
What information must be reported on dc 37 dental form?
The form must report personal details such as the member's name, address, membership number, dependent information, and coverage options chosen.
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