Medicare Portal Authorization - Jeanette Keller
I, , GIVE PERMISSION TO THE LAW OFFICE OF ROSENBAUM AND ASSOCIATES, TO SET UP A CLAIM AND OBTAIN MY MEDICARE INFORMATION FOR THIS CLAIM FROM THE MY MEDICARE PORTAL FOR THE DURATION OF THIS CLAIM FOR THE ACCIDENT OF .
My user name and password is as follows:USERNAME: __________________________________ PASSWORD: __________________________________
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Document Name: Medicare Portal Authorization - Jeanette Keller
Agree & Sign