Separately billing doctors questionnaire

Medical Expenditure Panel Survey - Household and Medical Provider Components

OMB: 0935-0118

IC ID: 191104

Documents and Forms

Document Name Document Type
Form Attachment 87 Separately billing doctors questionnaire Form and Instruction
Attachment 87 Attachment 87 – MPC Separately Billing Doctor Provider Questionnaire Attachment 87 – MPC Separately Billing Doctor Provider Questionnaire.docx Form and Instruction
Attachment 84 MPC SBD_Fax_AF_Packet.doc Attachment 84 – MPC Separately Billing Doctor Provider Authorization Form Package, Records to be Provided via Fax Anticipated IC Document
Attachment 85 MPC SBD_Phone_AF_Packet.doc Attachment 85 – MPC Separately Billing Doctor Provider Authorization Form Package, Phone Data Collection Anticipated IC Document
Attachment 86 MPC SBD_Overflow_Patient_List.docx Attachment 86 – MPC Separately Billing Doctor Provider Overflow Patient List IC Document