Document
Attachment 80 – MPC Office-Based Doctor Provider Authorization Form Package, Records to be Provided via Fax Anticipated
ICR 201802-0935-002 · OMB 0935-0118 · Object 80864401.
This document may belong to an older filing. More recent activity for OMB 0935-0118:
Document Viewer [doc]
Status: The document is viewable, but some background extraction is still pending.
Queue: Repair is in progress, but the document is still incomplete and remains in the worker queue. (priority 70 · next 2026-05-06 13:22:36)
Missing: html
Download: Source copy (doc)
Loading document viewer…
Document Metadata
| File Type | application/msword |
|---|---|
| File Title | Attachment 80 – MPC Office-Based Doctor Provider Authorization Form Package, Records to be Provided via Fax Anticipated |
| Author | jstockdale |
| Last Modified By | Dowd, Kathryn L. |
| File Modified | 2015-08-30 |
| File Created | 2015-08-30 |
| Conversion State | partial |