div class=ts-pagebuttonPage 1button div class=ts-image amp-img class=ts-thumb alt=Page 1: · PDF fileATLANTIC EYE INSTITUTE PA Signature of file Assignment of Benefits Financial Agreement Patient Name print Account Number 1 MEDICARE: I src=https:reader031vdocumentsnetreader031viewer20220304205aa6c8667f8b9ac8748eb88chtml5thumbnails1jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 2button div class=ts-image amp-img class=ts-thumb alt=Page 2: · PDF fileATLANTIC EYE INSTITUTE PA Signature of file Assignment of Benefits Financial Agreement Patient Name print Account Number 1 MEDICARE: I src=https:reader031vdocumentsnetreader031viewer20220304205aa6c8667f8b9ac8748eb88chtml5thumbnails2jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 3button div class=ts-image amp-img class=ts-thumb alt=Page 3: · PDF fileATLANTIC EYE INSTITUTE PA Signature of file Assignment of Benefits Financial Agreement Patient Name print Account Number 1 MEDICARE: I src=https:reader031vdocumentsnetreader031viewer20220304205aa6c8667f8b9ac8748eb88chtml5thumbnails3jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 4button div class=ts-image amp-img class=ts-thumb alt=Page 4: · PDF fileATLANTIC EYE INSTITUTE PA Signature of file Assignment of Benefits Financial Agreement Patient Name print Account Number 1 MEDICARE: I src=https:reader031vdocumentsnetreader031viewer20220304205aa6c8667f8b9ac8748eb88chtml5thumbnails4jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 5button div class=ts-image amp-img class=ts-thumb alt=Page 5: · PDF fileATLANTIC EYE INSTITUTE PA Signature of file Assignment of Benefits Financial Agreement Patient Name print Account Number 1 MEDICARE: I src=https:reader031vdocumentsnetreader031viewer20220304205aa6c8667f8b9ac8748eb88chtml5thumbnails5jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 6button div class=ts-image amp-img class=ts-thumb alt=Page 6: · PDF fileATLANTIC EYE INSTITUTE PA Signature of file Assignment of Benefits Financial Agreement Patient Name print Account Number 1 MEDICARE: I src=https:reader031vdocumentsnetreader031viewer20220304205aa6c8667f8b9ac8748eb88chtml5thumbnails6jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 7button div class=ts-image amp-img class=ts-thumb alt=Page 7: · PDF fileATLANTIC EYE INSTITUTE PA Signature of file Assignment of Benefits Financial Agreement Patient Name print Account Number 1 MEDICARE: I src=https:reader031vdocumentsnetreader031viewer20220304205aa6c8667f8b9ac8748eb88chtml5thumbnails7jpg width=142 height=106 layout=responsive amp-img divdiv