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24925 ProCertForm v1 100%

Please use this certification form to certify that the qualified patient listed below has hearing loss and requires the CaptionCall service to use the telephone in a manner that is functionally equivalent to a fully hearing person.

https://www.pdf-archive.com/2015/12/21/24925-procertform-v1/

21/12/2015 www.pdf-archive.com