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DENTAL REPORT First Report C-055 Progress Report C-887 Box 2415 Edmonton Alberta T5J 2S5 Fax 780 427-5863 1-800-661-1993 Authorization for dental services excluding emergency treatment must be obtained before proceeding with treatment. Worker cannot be charged directly. Please submit treatment plan preauthorization on standard dental claim form. Please print or type WCB Claim Number Personal Health Number Patient s Surname First Name Address Stre.

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