MEMORANDUM FOR: (check one)

 

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FROM:                                   CSC Bill Payer

           

SUBJECT:                             Medical Records--- For information only. 

 

CLAIMANT:___________________________FILE NUMBER #_____---___---______

 

 

The attached medical documents accompanied a bill that was submitted to the billing facility.

 

Please file in appropriate case file.

 

Number of pages attached:___________

 

                                                ______________________

                                                            Date