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Get Dd 2876 2008

Ailability and local MTF policy. Contact your TRICARE Service Center, preferred MTF or US Family Health Plan Member service for availability of PCMs/PCPs.) (Complete all that apply.) 1st CHOICE (1) PCM/PCP NAME Same as Sponsor MTF/CLINIC 2nd CHOICE (If known) Same as Sponsor (2) PCM/PCP SPECIALTY No Preference Family/General Practice Flight Medicine (3) PREFERRED No Preference Male PCM/PCP GENDER DD FORM 2876, JUNE 2008 Pediatrics Internal Medicine ORIGINAL: DETACH AND MAIL THIS COPY. C.

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