Dac Message 100763

<b>Dental Lack of Insurance</b><br><br>

If you are NOT covered by any dental insurance, please provide a signed statement that no insurance coverage exists for this injury or illness and provide the following if applies to your situation:
<ul>
<li>Statement from provider(s) must verify the date the dental injury or illness occurred and if it is disaster related
<li>Itemized bills/receipts (NOT STATEMENTS) from the provider(s) of service(s)
<li>Date of loss of Prescription Medication
<li>Receipts from the pharmacy showing the replacement cost of the medication
<li>Written verification from the pharmacy showing the prescription was filled prior to the disaster
<li>Written verification from your physician stating that your condition requires the medication
</ul>