MEMORANDUM FOR: (check one)

[ ] Jacksonville [ ] Jacksonville FAB [ ] National Office FAB

[ ] Denver [ ] Denver FAB [ ] National Office

[ ] Seattle [ ] Seattle FAB

[ ] Cleveland [ ] Cleveland FAB

FROM: CSC Bill Payer

SUBJECT: Medical Records--- For information only.

CLAIMANT:___________________________FILE NUMBER #_____---___---______

The attached medical documents accompanied a bill that was submitted to the billing facility.

Please file in appropriate case file.

Number of pages attached:___________

______________________

Date