Attachment 76 – MPC Home Care Provider Authorization Form Package, Records to be Provided via Fax Anticipated

Attachment 76 MPC HomeHealth_Fax_AF_Packet.doc

Medical Expenditure Panel Survey - Household and Medical Provider Components

Attachment 76 – MPC Home Care Provider Authorization Form Package, Records to be Provided via Fax Anticipated

OMB: 0935-0118