MEPS-MPC-Hospital

PATIENT LABEL

REPEATING IDENTICAL VISITS CONTINUATION SHEET
FOR
OFFICE-BASED PROVIDERS FOR REFERENCE YEAR 2005

M:\7690\7690.19.04\MPC 2005\Forms\OB\OB B6c ContSheet.doc - 1/26/2006 - 11:52 AM - cg

B6c. Please tell me the dates of those other visits.

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M:\7690\7690.19.04\MPC 2005\Forms\OB\OB B6c ContSheet.doc - 1/26/2006 - 11:52 AM - cg
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|__|__|
OFFICE
USE ONLY

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