Below are links to SF-DCT claim forms for
PROOF OF MANUFACTURER (POM)
CLASS 5 DISEASE & EXPEDITED RELEASE FORM
CLAIMANT INFORMATION GUIDE
DISEASE CLAIM FORMS FOR CLASS 5; CLASS 6.1; AND CLASS 6.2
If you need a Rupture Form, you may contact the CAC for a copy of the Form.
You must have sent your medical records to the SF-DCT prior to June 1, 2006
indicating you have an eligible rupture under the plan
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