Cms-r-262 Section B - 7a - Primary Care Physician - Base 1 Screen
The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
Appendix C - PBP_2008_screenshots_sec_b7
The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
OMB: 0938-0763
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0763 can be found here:
Document [doc]
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PBP 2008 Data Entry System Screens
Section B – 7a – Primary Care Physician – Base 1 Screen
Section B – 7a – Primary Care Physician – Base 2 Screen
Section B – 7b – Chiropractic Services – Base 1 Screen
Section B – 7b – Chiropractic Services – Base 2 Screen
Section B – 7b – Chiropractic Services – Base 3 Screen
Section B – 7b – Chiropractic Services – Base 4 Screen
Section B – 7c – Occupational Therapy – Base 1 Screen
Section B – 7c – Occupational Therapy – Base 2 Screen
Section B – 7d – Physician Specialist – Base 1 Screen
Section B – 7d – Physician Specialist – Base 2 Screen
Section B – 7e – Mental Health Services – Base 1 Screen
Section B – 7e – Mental Health Services – Base 2 Screen
Section B – 7e – Mental Health Services – Base 3 Screen
Section B – 7e – Mental Health Services – Base 4 Screen
Section B – 7e – Mental Health Services – Base 5 Screen
Section B – 7f – Podiatry Services – Base 1 Screen
Section B – 7f – Podiatry Services – Base 2 Screen
Section B – 7f – Podiatry Services – Base 3 Screen
Section B – 7g – Other Health Care Professionals – Base 1 Screen
Section B – 7g – Other Health Care Professionals – Base 2 Screen
Section B – 7h – Psychiatric Services – Base 1 Screen
Section B – 7h – Psychiatric Services – Base 2 Screen
Section B – 7h – Psychiatric Services – Base 3 Screen
Section B – 7h – Psychiatric Services – Base 4 Screen
Section B – 7h – Psychiatric Services – Base 5 Screen
Section B – 7i – Physical Therapy and Speech-Language Services – Base 1 Screen
Section B – 7i – Physical Therapy and Speech-Language Services – Base 2 Screen
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| File Type | application/msword |
| File Modified | 2006-12-20 |
| File Created | 2006-12-20 |
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