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The following documents can help you get more information about this Medicare Advantage Dual Care Plan (HMO SNP), enroll in a plan and more.
|Prescription Drug Forms|
|Mail- Order Physician New Prescription Fax Form|
|Pharmacy Mail-Order Form|
|Prescription Drug Claim Form (HMO SNP)|
|Medicare Part B vs. Part D Form|
|Authorization to Disclose Protected Health Information (PHI) Form|
|Automated Premium Payment (ACH) Form|
|CMS Appointment of Representative Form|
|Multi-language Interpreter Services|
|Notice of Privacy Practices|