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HEALTHCARE FSA ANNUAL ELECTION WORKSHEET MEDICAL DENTAL VISION
Office visit co-payments $_____ Prescription drugs for the plan year $_____ Vision exams LASIK or PRK eye surgery $_____ Over-the-counter drugs, non-prescription pain relievers, allergy meds $_____ and cold/flu ... Get Doc
Www.sos.idaho.gov
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Www.fda.gov
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