%PDF-1.4
%
1 0 obj
<>stream
2021-03-14T16:26:30-06:00
2021-03-14T16:26:30-06:00
PScript5.dll Version 5.2.2
Microsoft Word - 2016 11 Brock Health Manual Claim Form - PAYG PlanReception
endstream
endobj
2 0 obj<>
endobj
3 0 obj<>
endobj
4 0 obj<>/MediaBox[0 0 612 792]>>
endobj
5 0 obj
<>stream
x]YqYd٢dʦ#ٴα}ǽ/^$ܚEvʝs@|~[S:ufIʇ_r%@ܴw.iI|닅8%l{UoM'F/m\0xD߿ř4V!lc]{B!k}~؎w
m8>VM)mc<Tl%~ܕg>#t
KGwv:?Afi<@bK˿?Ta_D);?nUtмWך[_~,"-naX'l@f4ɭ5_^,M&3ٻ3q)O.:Ӯ✏8fmdzSK:>L)Mʜv1FKp}A fzGbqU0K+vV2`E?PHCK?GW&8+O[*&Zh
C⢣r(%JQdpW.DȫRN/nO}y
8N|;#2vNR9l}ׯc.
#=%}(^}
C`>GkNߖB%9swj/tmeV"GSAF `4'+/d9ύ>U?
Zz@wz~
ͿpQDљ FZ/"m{M#Ly0'v]NgS:?a2N#k48Co,ybQZuBy=t^ `ҥ-s,_?|G?DZA270,$BoQ#5(1s[tABcj
a7l
&iTFW-85
X Gp䠫͈
L-T˟;CF )=LsKwM
cl+=ț+#9>MJpx^3 {
8%)@BԓAp3< Bq[,q ~~wZM ivv!HR.QߧTȬH+Cyí偊R
~6Vzt6
흆D}oA{Wny%]b/ܸ 7h`" qeEI[*mqU6aE.H㠤JV` 5\2:БtC/k$fѬ`T#0m`aKm
&j۸SEFUӕ6(9̖5,{YF1"qBk:${a _`08[1#+MGqSڄ2T1<699rDN)}s
]?kd ud6Eٝkxr1ÌSp0?n|`s#{k_xJXnZNY~&2?cN_ lz >f½m,P*L2SpD%rMt
6
iIԱ/Fhm<[p
SHfO:+бr,vFnU7ZW{XudX,
!`F]hpk>SJ&5h[߇nAsCW[P[̲k-6OK*R?gu45Cg&4&̰qp>c%g``t$JSs),KSX`B#㡏aÌBԧZIKJ.8 C߅aǹ盗:=Ķ9usH}l-}\8a6v5!Dfls|Crҵ'HXX q^B nc1
n\!O:y;
X4v3M2` B9#2ۂeF6!2߅{!BCG$&¡fMLܚp]jƊsyE ڏL=I`&%W<)I)
&v(:vxMv1aaAa]{9HEXfls"a"aGLu!S]ԡAvm#T#Pf`BՊ]
\k8W L0=I`&%W<)I)v(^vxΙvhQe6v!b0"f#bQa]{91ՅLu1SMصHRNB͚]U+v
v.*pŮ\j^kSf=vMJ3)IɵLJaEaNإ.FÌb8,39k31ˌmC$C̑.d:4h®mD=Lَ51l
]l+Υ&;cפd0+\ˤvik
Pva],.F.#"4,39k m$p.^:4bLm@fbjYZ1kcfQ+fRY@{[f%TZf%3Y$2lN%âqڥ!: Hx#OeF6!n!"Δ.d:4hBmDEF;bfvv..pfTq.5b_[LJxRr-RؕuĢ+\ar~Qb4(2` s0(0D®=DBC&F$'vfͮم;fbXq.55ټfפd0+\ˤvṡEa7eu]v1aaAa]{9HEXfls"a"aGLu!S]ԡAvm#THf`BՊ]
\k8W ENJ3)IɵLJa&Eaإ&
3 0@®=DFČbD,3
9k3G".fР I]YkcvjŮE5VK+vM 1v*ǮI`&%W<)I)첪$(ҹ$x`EpYFz, 0@̮]DUOˌmCE$Q$Lu1SٵHRu:I&͚]U+v
v.*pŮ\j^ksY`&%W<)I)Ҷ$(R$xǗhQ$9k0֓dA2` sl=I.!S]ԡAvm#TI2i]ZkcvQ+vR]@{28]JxVR-eОE"ˤPNE<]>?4(2` s1J(0D®=DĜ1ՅLu1SMصHRu:I&͊]T3F;b8k8gv 1vz}<+̤'%2)]I.]!.cwа0=fRrœk.1.e鱈˅;η0c6v!zz,Xfls"a"a%d:4h®mD1i]ZkcvQ+vR]@{9Og%TZf彜sA#DKFy7p`Dx7pEQcxϷI/,a*)_X =-u0}?%H7ˠ1HRDd=x#CpK>RK6!
H
yS; TmD_SlOEo_Zt6e;t8E*ߪȽ/%&)AXZ5hx
vn
-txnأLІ#B.S_` TD2 3|i[Fʼkbn?W,]W\i
[#4IW<$}uE:t}dΟ*
D[,:tG vht% @r<*DoθW~ng?^fb>\nDivTץ.Ԕ{O/:`+kU- 8%
~w:z3CV(lPm
'oOc
_GiyLla뇰hL9l &ކ|ꇸt:qx dY#>|e9 Fy 2 hGd.p OR"oTra3k) h;8?}1iWӅx5E,םH^.+4^MȂRɲ$0)KR[*
As 2b"Th