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“Standard Offset Walking Cane Adjustable Aluminum” has been added to your cart. Continue shopping

Product	Price	Quantity	Subtotal
HurryCane Freedom Edition Folding Cane	$44.99	HurryCane Freedom Edition Folding Cane quantity	$44.99
Standard Offset Walking Cane Adjustable Aluminum	$35.99	Standard Offset Walking Cane Adjustable Aluminum quantity	$35.99

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Subtotal	$80.98
Total	$80.98

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Workers Comp Claim Insurance Purchase Request

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Insurance Type

Medicare

Mediciad

No Fault

Workers Comp

Other

Insurance Provider(Required)

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Documents Section Upload (i.e. prescriptions)

Max. file size: 2 GB.

I agree to allow CapsuleAID and its authorized representatives to contact me about my medical supplies, orders, and related subject.(Required)

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Other Claim Insurance Purchase Request

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Name(Required)

First Name Last Name

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Insurance Type

Medicare

Mediciad

No Fault

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Other