Dac Message 5673

<p><strong>Medical Miscellaneous Document</strong><br /> (medical provider(s) statement, insurance denial letter, explanation of benefits statement(s), itemized bill or receipts)</p> <p>Please make sure your document includes:</p> <ul> <li>Your name.</li> <li>Your home address listed on your application.</li> <li>The date of the medical injury or illness.</li> <li>The name of your medical or health insurance provider.</li> <li>The telephone number of your service provider.</li> <li>Your insurance policy number.&nbsp;</li> <li>Your type of coverage.</li> <li>Proof that your prescription was filled before the disaster.</li> <li>A brief explanation stating that your condition requires the medication.</li> </ul>