Attachment 80 – MPC Office-Based Doctor Provider Authorization Form Package, Records to be Provided via Fax Anticipated

Attachment 80 MPC OBD_Fax_AF_Packet.doc

Medical Expenditure Panel Survey - Household and Medical Provider Components

Attachment 80 – MPC Office-Based Doctor Provider Authorization Form Package, Records to be Provided via Fax Anticipated

OMB: 0935-0118