.ig
	Instructions:

	Make a file that looks something like this:

.so /sys/lib/tmac/tmac.hform
.EN "Grace R. Emlin"	\" employee's name
.ES "314-15-9265"	\" employee's soc. sec. number
.EA "Apt. 2C501, 600 Mountain Ave., Murray Hill, NJ 07974" \" employee's address
.PN "Samantha X. Emlin"	\" patient's name
.PB "7/13/90"		\" patient's birth date
.NI "See attached"	\" nature of illness
.OE "Fly-By-Night Corp., 123 Airport Way, Long Island City" \" other employer
.OT "516" "666-4911"	\" other employer's area code and phone number
.DN "Samantha X. Emlin"	\" dependent's name
.DS "271-82-8182"	\" dependent's soc. sec. number
.DE "Underwearer's Laboratories (Disposables Division)"	\" dependent's employer
.DI "none"		\" dependent's insurance
.DT ""			\" today's date
.TF "a" "m"		\" a=active, r=retired; p=pay physician, m=pay me

	If you leave the \" comments in your file, REMEMBER
	TO QUOTE THE ARGUMENTS, ESPECIALLY .TF "a" "m".
	Order is arbitrary, except that .TF must come last.
	Omit macro to leave corresponding field blank.
	.DT "anything" will supersede today's date.
	For best results, print using:

		troff -T202 file | gcan

	Spacing on postscript printers is not guaranteed.
..
.ds SQ \s+3\v'0.15n'\(sq\v'-0.15n'\s0
.de TF
.bp
.vs 1u
.ll 7i
.po 0
.in 0
.sp |0.45i
.ps 40
.nr L1 \w'\(L1'
\(L1
.sp -1
.sp -0.6n
.ft HB
.ps 18
\h'\\n(L1u'A\h'-0.4n'T\h'-0.4n'\s13&\s0\h'-0.4n'T
.sp |0.10i
.in 1.4i
.ps 8
.ft H
\\*(SQ Active
.sp -1
.if '\\$1'a' \{\
\f(CW\s10x\s0\fP
.sp -1 \}
.sp .12i
\\*(SQ Retired
.if '\\$1'r' \{\
.sp -1
\f(CW\s10x\s0\fP\}
.sp -1 \}
.in 0
.ps 11
.sp |0.20i
.ce 1
TRANSMITTAL FORM
.ps 9
.sp |0.20i
.ta 7iR
\&	PRINT CLEARLY AND SIGN BELOW
.sp |0.45i
.ps 10
.ta 3.5i 7.0i
.lc _
.vs 0.22i
Employee Name:\\kh\s6\&
\s0\& Employee Soc. Sec. No:\\ki\s6\&
\s0\&
.sp -1
\h'|\\nhu'\\*(En\h'|\\niu'\\*(Es
.br
.ta 7.0i
Employee Address:\\kh\s6\&
\s0\&
.sp -1
\h'|\\nhu'\\*(Ea
.br
.ta 4.7i 7.0i
Patient Name:\\kh\s6\&
\s0\& Date of Birth:\\ki\s6\&
\s0\&
.sp -1
\h'|\\nhu'\\*(Pn\h'|\\niu'\\*(Pb
.br
.ta 7.0i
Nature of Illness or Injury\\kh\s6\&
\s0\&
.sp -1
\h'|\\nhu'\\*(Ni
.sp -1
.sp 0.07i
\l'7i\(ul'
.sp -1
\h'5.4i'\L'0.31i'
.sp -1
.sp 0.10i
.ps 6
DO YOU HAVE ANOTHER EMPLOYER? \f(HI(If yes, give name and address of other employer)\fP
.sp -1
\h'5.47i'EMPLOYER TELEPHONE NUMBER
.sp -1
\h'5.55i'\v'0.10i'AREA CODE\v'-0.10i'
.sp -1
\h'6.40i'\v'0.10i'NUMBER\v'-0.10i'
.sp -1
.sp 0.22i
\l'7i\(ul'
.sp -1
\h'6.20i'\L'-0.14i'
.sp -1
\v'-0.05i'\\*(SQ\ \ Yes\h'|0.6i'\\*(SQ\ \ No\v'0.05i'
.sp -1
.ie '\\*(Oe'' \h'|0.6i'\v'-0.05i'\f(CW\s10x\s0\fP\v'0.05i'
.el \v'-0.05i'\f(CW\s10x\h'|0.85i'\\*(Oe\s0\fP\v'0.05i'
.sp -1
.if !'\\*(Oa'' \{\
\h'|5.7i'\v'-0.02i'\\*(Oa\v'0.02i'
.sp -1 \}
.if !'\\*(Ot'' \{\
\h'|6.3i'\v'-0.02i'\\*(Ot\v'0.02i'
.sp -1 \}
.sp 0.1i
.ce
Complete below if claim is for your dependent/spouse
.sp -1
.sp 0.2i
.ps 10
.ta 3.5i 7.0i
DEP./SPOUSE Name:\\kh\s6\&
\s0\& DEP./SPOUSE Soc. Sec. No.:\\ki\s6\&
\s0\&
.sp -1
\h'|\\nhu'\\*(Dn\h'|\\niu'\\*(Ds
.br
.ta 7.0i
DEP./SPOUSE Employer:\\kh\s6\&
\s0\&
.sp -1
\h'|\\nhu'\\*(De
.br
DEP./SPOUSE Benefit Plan No. and Insurer:\\kh\s6\&
\s0\&
.sp -1
\h'|\\nhu'\\*(Di
.br
.ta 2.65i 4.0i
I hereby direct payment to be made to:	\\*(SQ My Physician	\\*(SQ Myself
.sp -1
.if '\\$2'p' \&	\f(CW\s10\v'-0.15n'x\v'0.15n\s0\fP'
.if '\\$2'm' \&		\f(CW\s10\v'-0.15n'x\v'0.15n'\s0\fP
.sp -1
.sp 0.1i
.ta 7.0i
.ps 18
\l'7i\(ul'
.sp -1
\h'0.08i'\v'0.13i'\s6ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURANCE COMPANY, FILES A STATEMENT OF CLAIM CONTAINING ANY\s0\v'-0.13i'
.sp -1
\h'0.08i'\v'0.23i'\s6FALSE, INCOMPLETE OR MISLEADING INFORMATION MAY BE GUILTY OF A CRIMINAL ACT PUNISHABLE UNDER LAW.\s0\v'-0.23i'
.sp -1
\L'0.22i'
.sp -1
\h'6.99i'\L'0.22i'
.sp -1
.sp 0.255i
\l'7i\(ul'
.sp -1
.sp 0.25i
.ta 1.9i 7.0i
.ps 10
Date:\\kh\s6\&
\s0\& Signature:\s6\&
\s0\&
.sp -1
\h'|\\nhu'\\*(Dt
.sp -1
.sp .25i
.ps 7
GI-59970\h'0.1i'(BACK)
.sp -1
.sp .1i
\l'7i\(ul'
.sp -1
.ps 10
.sp
.ta 1i
.nf
Mail to:	The Prudential
.in 1i
AT&T Medical Plan
P.O. Box 5060
Millville, NJ  08332
.cL
..
.de dE
.de \\$1
.ds \\$2 \f(CW\s10 \\\\$1\s0\fP
\\..
..
.dE EN En
.dE ES Es
.dE EA Ea
.dE PN Pn
.dE PB Pb
.dE NI Ni
.dE DN Dn
.dE DS Ds
.dE DE De
.dE DI Di
.de OE
.ds Oe \\&\\$1
..
.de OT
.ds Oa \f(CW\s10\\$1\s0\fP
.ds Ot \f(CW\s10\\$2\s0\fP
..
.de DT
.ie '\\$1'' .ds Dt \f(CW\s10 \\n(mo/\\n(dy/\\n(yr\s0\fP
.el .ds Dt \f(CW\s10 \\$1\s0\fP
..
.de cL
.ds En
.ds Es
.ds Ea
.ds Pn
.ds Pb
.ds Ni
.ds Dn
.ds Ds
.ds De
.ds Di
.ds Oe
.ds Oa
.ds Ot
.ds Dt
..
.cL