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SECTION IV: Services and Supplies To Be Considered For Reimbursement These may include ambulance services, medical appliances, diabetic supplies, glasses and/or contact lenses or outofnetwork services.
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Individuals or organizations that have purchased or distributed self-care equipment must file 90 self-care equipment.
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To fill out the form, provide details such as personal information, equipment specifics, purchase date, and any relevant certifications or licenses.
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Required information includes the type of equipment, purchase details, user information, and any safety or compliance certifications.
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