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Paacc Fit Reimbursement Form 2019

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PaACC FIT Reimbursement Form 2019

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Personal Information

Email*

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Phone Number*

Medical School*

10.

Year of Graduation*

11.

Email Address*

Description:PaACC FIT Reimbursement Form 2019

The PaACC FIT Reimbursement Form 2019 is a template designed for healthcare professionals to claim reimbursement for the cost of the FIT (fecal immunochemical test) screening kit. The form includes sections for personal information, test information, and cost information. By using this template, healthcare professionals can streamline the reimbursement process and ensure accurate and timely payment. This form is specifically designed for use in 2019 by members of the Pennsylvania Chapter of the American College of Cardiology.

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