%PDF-1.6
%
1 0 obj<>
endobj
4 0 obj<>/Subtype/Widget/T(1719CC2C93C9A947AAC499421BDC1715.1)/DR<>>>/Ff 65536/FT/Btn/A<>>>/BS<>/Rect[487 772 556 788]/AP<>/DA(/HeBo 9 Tf 1 1 1 rg )/TU(Click this button to save changes you have made.)/Type/Annot>>
endobj
6 0 obj<>/Subtype/Widget/T(1719CC2C93C9A947AAC499421BDC1715.SaveAs.1)/DR<>>>/Ff 65536/FT/Btn/A<>>>/BS<>/Rect[558 772 609 788]/AP<>/DA(/HeBo 9 Tf 1 1 1 rg )/TU(Click this button to save changes to a new file.)/Type/Annot>>
endobj
8 0 obj<>/Subtype/Widget/T(1719CC2C93C9A947AAC499421BDC1715.Reset.1)/DR<>>>/Ff 65536/FT/Btn/A<>/BS<>/Rect[3 772 38 788]/AP<>/DA(/HeBo 9 Tf 1 1 1 rg )/TU(Click this button to clear form.)/Type/Annot>>
endobj
10 0 obj<>/Subtype/Widget/T(1719CC2C93C9A947AAC499421BDC1715.2)/DR<>>>/Ff 65536/FT/Btn/A<>>>/BS<>/Rect[3 4 72 20]/AP<>/DA(/HeBo 9 Tf 1 1 1 rg )/TU(Click this button to save changes you have made.)/Type/Annot>>
endobj
12 0 obj<>/Subtype/Widget/T(1719CC2C93C9A947AAC499421BDC1715.SaveAs.2)/DR<>>>/Ff 65536/FT/Btn/A<>>>/BS<>/Rect[74 4 125 20]/AP<>/DA(/HeBo 9 Tf 1 1 1 rg )/TU(Click this button to save changes to a new file.)/Type/Annot>>
endobj
14 0 obj<>/Subtype/Widget/T(1719CC2C93C9A947AAC499421BDC1715.3)/DR<>>>/Ff 65536/FT/Btn/A<>>>/BS<>/Rect[487 772 556 788]/AP<>/DA(/HeBo 9 Tf 1 1 1 rg )/TU(Click this button to save changes you have made.)/Type/Annot>>
endobj
16 0 obj<>/Subtype/Widget/T(1719CC2C93C9A947AAC499421BDC1715.SaveAs.3)/DR<>>>/Ff 65536/FT/Btn/A<>>>/BS<>/Rect[558 772 609 788]/AP<>/DA(/HeBo 9 Tf 1 1 1 rg )/TU(Click this button to save changes to a new file.)/Type/Annot>>
endobj
18 0 obj<>/Subtype/Widget/T(1719CC2C93C9A947AAC499421BDC1715.4)/DR<>>>/Ff 65536/FT/Btn/A<>>>/BS<>/Rect[3 4 72 20]/AP<>/DA(/HeBo 9 Tf 1 1 1 rg )/TU(Click this button to save changes you have made.)/Type/Annot>>
endobj
20 0 obj<>/Subtype/Widget/T(1719CC2C93C9A947AAC499421BDC1715.SaveAs.4)/DR<>>>/Ff 65536/FT/Btn/A<>>>/BS<>/Rect[74 4 125 20]/AP<>/DA(/HeBo 9 Tf 1 1 1 rg )/TU(Click this button to save changes to a new file.)/Type/Annot>>
endobj
3 0 obj<>
endobj
7 0 obj
<>>>/Filter/FlateDecode/Length 146/FormType 1/BBox[0 0 35 16]/Type/XObject>>stream
xm0E厰Uba YH+BEaL0GlaᰌAQ=bz /HnNrkYR[B4Dmp#u~Ͷx@4RD0mաcg=z 61
endstream
endobj
5 0 obj
<>>>/Filter/FlateDecode/Length 149/FormType 1/BBox[0 0 51 16]/Type/XObject>>stream
xm
1_u饱ʁXpȩx&=t|@[SA/A1La`IJ%dzG AH
u,?GJ4e4ے=UJpzƘeأ42
endstream
endobj
19 0 obj
<>>>/Filter/FlateDecode/Length 149/FormType 1/BBox[0 0 51 16]/Type/XObject>>stream
xm
1_u饱ʁXpȩx&=t|@[SA/A1La`IJ%dzG AH
u,?GJ4e4ے=UJpzƘeأ42
endstream
endobj
9 0 obj
<>>>/Filter/FlateDecode/Length 152/FormType 1/BBox[0 0 69 16]/Type/XObject>>stream
xm10Fui&Z-8gb{:p)(\v5dwF?h+4_(Q2?IssM2M@˞?3l}35v#U`M%s4
endstream
endobj
15 0 obj
<>>>/Filter/FlateDecode/Length 149/FormType 1/BBox[0 0 51 16]/Type/XObject>>stream
xm
1_u饱ʁXpȩx&=t|@[SA/A1La`IJ%dzG AH
u,?GJ4e4ے=UJpzƘeأ42
endstream
endobj
13 0 obj
<>>>/Filter/FlateDecode/Length 152/FormType 1/BBox[0 0 69 16]/Type/XObject>>stream
xm10Fui&Z-8gb{:p)(\v5dwF?h+4_(Q2?IssM2M@˞?3l}35v#U`M%s4
endstream
endobj
11 0 obj
<>>>/Filter/FlateDecode/Length 149/FormType 1/BBox[0 0 51 16]/Type/XObject>>stream
xm
1_u饱ʁXpȩx&=t|@[SA/A1La`IJ%dzG AH
u,?GJ4e4ے=UJpzƘeأ42
endstream
endobj
17 0 obj
<>>>/Filter/FlateDecode/Length 152/FormType 1/BBox[0 0 69 16]/Type/XObject>>stream
xm10Fui&Z-8gb{:p)(\v5dwF?h+4_(Q2?IssM2M@˞?3l}35v#U`M%s4
endstream
endobj
2 0 obj
<>>>/Filter/FlateDecode/Length 152/FormType 1/BBox[0 0 69 16]/Type/XObject>>stream
xm10Fui&Z-8gb{:p)(\v5dwF?h+4_(Q2?IssM2M@˞?3l}35v#U`M%s4
endstream
endobj
21 0 obj
<>stream
2015-10-30T16:30:09-07:00
2015-09-16T10:55:23-04:00
2015-10-30T16:30:09-07:00
Acrobat PDFMaker 10.1 for Word
uuid:fa570ef2-e04c-4661-8b21-212d2f6ceb7e
uuid:cb59cec5-a693-4ab1-84e2-90cd4a7b526a
2
application/pdf
Medicare Part D Prescription Claim Form
Adobe PDF Library 10.0
D:20150916145517
CVS
D:20120916
D:20150915
1
1.1
endstream
endobj
22 0 obj<>/ProcSet[/PDF/Text]/Font<>>>/Tabs/S/Contents 30 0 R/MediaBox[0 0 612 792]/Annots 31 0 R/Parent 32 0 R/Rotate 0/Type/Page>>
endobj
30 0 obj
<>stream
HWn}Wp~ `1eh^ksiשS>\}Z_>t^ysBNN;YmNWO_6_Owoޞu_c4VzPYc6|
Auqn,
oSVoVA .q]VABvmTTJoP\Y\D8O?Gc 0O%5>-wQ6׃7QqL+T1_E,R8
uBtɲB5rAfOOB zJErfiFi9(ᾒ)
VD?(x\J9Xa37sd6t+kv9ZAفw1܇s38Dn7OTHr*i f3i'R
v'|`u"c*P,;lr3ܞs;XL<:$ګ
@R2bX^\&:4w!3K ܱ*