Form 1 FTCA Free Clinic Application
Free Clinics FTCA Program Application
FTCA Free Clinic Application Screenshots
Free Clinics FTCA Program Application
OMB: 0915-0293
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0915-0293 can be found here:
Document [docx]
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TOC Main Page
Contact Information
Site Information
Sponsoring Free Clinic Eligibility
Credentialing and Privileging Systems
Risk Management Systems
Individuals
Remarks
Signatures
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Sarah Florer |
| File Modified | 0000-00-00 |
| File Created | 2021-01-27 |
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