VAMC SLUMS Examination - School of Medicine

Health Benefits Election Form Form Approved: OMB No. 3206-0160 Standard Form 2809 ... home address. Item 19. If your family member has Medicare, check which Parts (Part A [Hospital Insurance] and/or Part B [Medical ... unless you are required to make direct payments to the employing office. Part D — Event That Permits You To Enroll, Change, ... ................
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