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Get How Do I Fill The Argus Prescription Claim Form 1991-2024

EXPLAIN RELATIONSHIP MAIL ADDRESS STREET ( CITY / PATIENT S DATE OF BIRTH (MM/DD/YY) CUSTOMER ID I certify that I (or my eligible dependent) have received the medication described herein and that the patient named is eligible for drug benefits. I also certify that the medication received is not for the treatment of an on-the-job injury, or covered under another benefit plan unless Part Two is completed. I authorize release of all information pertaining to this claim to Argus Health.

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