Attachment 82 – MPC Office-Based Doctor Provider Overflow Patient List
Attachment 82 MPC OBD_Overflow_Patient_List.docx
Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC)
Attachment 82 – MPC Office-Based Doctor Provider Overflow Patient List
OMB: 0935-0118
OMB#: 0935-0118
Medical Expenditure Panel Survey – Medical Provider
Component
Reference #: «GID»
Attachment 82 – MPC Office-Based Doctor Overflow Patient List
Confidential
Patient Checklist – (Continued)
PLEASE RETURN
|
|
|
|
|
|
|
|
|
Provider Name |
Patient Name |
Date of Birth |
Gender |
2014 Patient |
Patient Located - |
Is Not |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Edrina Bailey |
| File Modified | 0000-00-00 |
| File Created | 2021-01-20 |
© 2024 OMB.report | Privacy Policy