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Medical and Dental - Electronic Submission

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Member ID:help      
Group No.:help      
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Upload File:help      
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Please note: The uploaded file must be DOC, DOCX, PDF, GIF, JPG, PNG, TIFF or TIF in format. The uploaded file must be less than 10MB in size.
Please note:Renaming a non-supported file type to supported file types will not be accepted. EXAMPLE: myfsareceipt.png to myfsareceipt.pdf
Browsers supported: IE, Firefox, Mozilla, Netscape.