Attachment 86 – MPC Separately Billing Doctor Provider Overflow Patient List

Attachment 86 MPC SBD_Overflow_Patient_List.docx

Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC)

Attachment 86 – MPC Separately Billing Doctor Provider Overflow Patient List

OMB: 0935-0118

Document [docx]
Download: docx | pdf

OMB#: 0935-0118




Medical Expenditure Panel Survey – Medical Provider Component



Reference #: «GID»

A

Confidential Patient Checklist – (Continued)
PLEASE RETURN


ttachment 86 – MPC SBD Overflow Patient List








CHECK ONE FOR

EACH PATIENT


Provider Name




Provider Specialty




Hospital Name

Patient Name

Date of Birth

Gender

2014
Records Located

2014 Records

NOT

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorEdrina Bailey
File Modified0000-00-00
File Created2021-01-15

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