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DO NOT USE FOR INTERNAL PURPOSES ONLY HIS ID# EC A nonprofit independent licensee of the Blue Cross Bluesier Association P.O. Box 22999, Rochester, NY 14692 Instructions on last page. All Dates mm/dd/by
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Do not use is a form used to report an individual's refusal to use a certain product, service, or feature.
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Any individual who chooses not to use a specific product, service, or feature may be required to file a do not use form.
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To fill out a do not use form, you will need to provide your personal information, details of the product/service/feature you are refusing to use, and the reason for your refusal.
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The purpose of a do not use form is to officially document an individual's decision to not use a particular product, service, or feature.
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Information reported on a do not use form typically includes the individual's name, contact information, the product/service/feature being refused, and the reason for refusal.
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