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Lehighton Ambulance
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Donations
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Claim Signature
Donors
Careers
Lehighton Ambulance
Home
About
Donations
Bill Pay
Subscription
Claim Signature
Donors
Careers
More
Home
About
Donations
Bill Pay
Subscription
Claim Signature
Donors
Careers
Claim Signature Form
In compliance with Medicare regulations, your signature is required before we can submit this claim to Medicare. No payment is due at this time, as this is just a request for signature authorization to submit the claim.
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