Document
Attachment 84 – MPC Office-Based Doctor Provider Authorization Form Package, Records to be provided via Fax Anticipated
ICR 201907-0935-002 · OMB 0935-0118 · Object 93247601.
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 queued and waiting for the next worker pass. (priority 70 · next 2026-05-30 07:09:40)
Missing: html
Download: Source copy (doc)
Loading document viewer…
Document Metadata
| File Type | application/msword |
|---|---|
| File Title | Attachment 84 – MPC Office-Based Doctor Provider Authorization Form Package, Records to be provided via Fax Anticipated |
| Author | jstockdale |
| Last Modified By | SYSTEM |
| File Modified | 2018-09-12 |
| File Created | 2018-09-12 |
| Conversion State | partial |