information request medicare

Description
Form Approved OMB No. 0990-0243 Exp. Date 03/31/2014 DEPARTMENT OF HEALTH HUMAN SERVICES Office for Civil Rights OCR Civil Rights Information Request For Medicare Certification Instructions Healthcare providers applying for participation in the Medicare Part A program must receive a civil rights clearance from OCR. Complete all fields and return this form with the required polices and procedures to your State...
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information request medicare
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