Effective Dates: 02/01/2024 - Present Previous | Next

TN 12 (02-24)

HI 00630.180 List of Exhibits - Medicare Outside U.S.

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    Exhibit 1—Form CMS-1739

    Exhibit 2—Form CMS-40F

    Exhibit 3—Form CMS-40B

Exhibit 1—CMS-1739

FORM 1739

Exhibit 2—CMS-40F

CMS 40 F
CMS 40 F

Exhibit 3 CMS-40B English Form

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600630180
HI 00630.180 - List of Exhibits - Medicare Outside U.S. - 02/01/2024
Batch run: 02/01/2024
Rev:02/01/2024