Documents tagged "Drug Coverage Enrollment Form"

Found 1 document with this tag

DOJ-OGR-00026767.jpg

The image displays a document titled "U.S. Department of Health and Human Services Medicare Prescription Drug Coverage Enrollment Form". The form appears to be related to healthcare insurance for prescriptions in the United States. It contains sections that are typically found on official documents, such as fields for personal information, checkboxes, and places to fill out answers or responses. There's also a pink stripe running down the middle of the document, which is often used to separate different sections or to add emphasis. The text "Medicare Prescription Drug Coverage" is prominently displayed at the top.

Human Services Medicare Prescription Drug Coverage Enrollment Form United States Medicare Prescription Drug Coverage Department Health Human Services Medicare Prescription Drug Coverage Enrollment Form United States