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Medicare Advisors Group

SageScope

Please verify the details below.
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Rx
- Rx
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MAPD
- MAPD
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Other
- Other
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Client Signature
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Client Signature Date
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POA
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POA Relation
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Agent Name
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Agent Phone
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Agent Address
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Client Name
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Client Phone
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Client Address
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Initial Contact*
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Agent Signature
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Agent Plans
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Appointment Date
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Explanation
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Agent Notification & Filename
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Agent Email
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Names Combined
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Filename