📄 Extracted Text (88 words)
S.
( \--vBeneficiary or his/her legal representative understands that Medi-Gap plans do
nk, and that other supplemental plans may elect not to, make payments for items and
services not paid for by Medicare.
l\--Beneficiary or his/her legal representative acknowledges that the beneficiary is not
cukently in an emergency or urgent health care situation.
Beneficiary or his/her legal representative acknowledges that a copy of this
confr.acti has been made available to him.
Executed on:
1111111111
1111
2935318
EPSTEIN,JEFFREY
01/20/1953
Date: gae? Initial:___ Date:
By:
And:
Darius Paduch, M.D.
EFTA00314072
ℹ️ Document Details
SHA-256
78dcea87e7ae86f85930458177b4da69c6f5865a812828ed86988e6e59936c92
Bates Number
EFTA00314072
Dataset
DataSet-9
Document Type
document
Pages
1
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