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Medicare Advisors Group

SageScope

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