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Industry Generic Long Term Disability eForm

From Chris Sedegren - Attached is the Insurance Industry generic Long Term Disability eForm html and pngs. Also attached is a sample form (in PDF) once again completed on my dear old friend and patient, Bilbo Baggins, so that you can get an idea as to what the completed form looks like. This time I was able to use 14 point font, which makes it much easier to read. The areas that the patient is required to complete are highlighted in yellow. Please feel free to adapt and modify as you see fit. Chris.

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