Form CMS-18F5 Application for Part A (Hospital Insurance)
Application for Enrollment in Medicare Part A, Internet Claim (iClaim) Application Screen, Modernized Claims System and Consolidated Claim (CMS-18F5)
CMS 18_F_5-Final
Application for Part A (Hospital Insurance)
OMB: 0938-0251
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0251 can be found here:
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