OMB#:  0935-0118 
 
 
	
	
 
	
		Medical Expenditure Panel Survey – Medical Provider
		Component 
	
Reference #: «GID»
Attachment 81 – MPC Home Care Provider Patient Overflow List
	Confidential
	Client Checklist – (Continued) 
PLEASE RETURN
	
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				 | Provider Name | Client Name | Date of Birth | Gender | 
				2017 Client | 
				Client Located -  | 
				Is Not  | 
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | Edrina Bailey | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-20 |