Document
Health Center Patient Survey Patient Screening Form
ICR 201912-0915-001 · OMB 0915-0368 · Object 99676301.
This document may belong to an older filing. More recent activity for OMB 0915-0368:
Document Viewer [docx]
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 2026-05-11 11:31:41)
Missing: html
Download: Source copy (docx)
Loading document viewer…
Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Health Center Patient Survey Patient Screening Form |
| Author | Tim Flanigan |
| File Created | 2021-01-14 |
| Conversion State | partial |