| Assigned Number | Title | Release Date Sort ascending | File Type | Language | Available to Order |
|---|---|---|---|---|---|
| F-01567A | Letter: Request for Assignment of Medical Benefits | 01/29/2021 | Word | English | No |
| F-01567S | Long-Term Care Insurance Policy - Assignment of Benefits, Spanish | 12/12/2018 | Spanish | No | |
| F-01567 | Long-Term Care Insurance Policy - Assignment of Benefits | 12/12/2018 | Word | English | No |
| F-01567 | Long-Term Care Insurance Policy - Assignment of Benefits | 12/12/2018 | English | No |
Last revised May 12, 2025