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Randall County Texas

501 16th Street , STE 204 , Canyon , TX, 79015, US

Benny Card Report

Please use this form to submit your receipts monthly

Your Benny Card will be suspended unless you attach all proof of receipts to this form within 45 days.

You may take pictures from any device in order to make this submission.

Under penalties of perjury, by submitting these reciepts, I swear that all medical expenses have been incurred according to the benefit card policy and procedures and that expenses reported have not been reimbursed under any health

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