km c554e afm healthcare-20191118100247€¦ · assignment 1 acknowlegement i hereby assign all...

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Page 1: KM C554e AFM Healthcare-20191118100247€¦ · ASSIGNMENT 1 ACKNOWLEGEMENT I hereby assign all medical and surgical benefits, to include major medical benefits to which I am entitled,
Page 2: KM C554e AFM Healthcare-20191118100247€¦ · ASSIGNMENT 1 ACKNOWLEGEMENT I hereby assign all medical and surgical benefits, to include major medical benefits to which I am entitled,
Page 3: KM C554e AFM Healthcare-20191118100247€¦ · ASSIGNMENT 1 ACKNOWLEGEMENT I hereby assign all medical and surgical benefits, to include major medical benefits to which I am entitled,
Page 4: KM C554e AFM Healthcare-20191118100247€¦ · ASSIGNMENT 1 ACKNOWLEGEMENT I hereby assign all medical and surgical benefits, to include major medical benefits to which I am entitled,
Page 5: KM C554e AFM Healthcare-20191118100247€¦ · ASSIGNMENT 1 ACKNOWLEGEMENT I hereby assign all medical and surgical benefits, to include major medical benefits to which I am entitled,
Page 6: KM C554e AFM Healthcare-20191118100247€¦ · ASSIGNMENT 1 ACKNOWLEGEMENT I hereby assign all medical and surgical benefits, to include major medical benefits to which I am entitled,