Attachment 90 – MPC Separately Billing Doctor Provider Overflow Patient List

Attachment 90 – MPC Separately Billing Doctor Provider Overflow Patient List.docx

Medical Expenditure Panel Survey (MEPS) COVID-19 Changes

Attachment 90 – MPC Separately Billing Doctor Provider Overflow Patient List

OMB: 0935-0118

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OMB#: 0935-0118




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Medical Expenditure Panel Survey – Medical Provider Component



Reference #: «GID»

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Confidential Patient Checklist – (Continued)
PLEASE RETURN


Attachment 90 – MPC SBD Overflow Patient List








CHECK ONE FOR

EACH PATIENT


Provider Name




Provider Specialty




Hospital Name

Patient Name

Date of Birth

Gender

2017
Records Located

2017 Records

NOT

Located









































































































































































































File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorEdrina Bailey
File Modified0000-00-00
File Created2022-10-06

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