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Attachment 89 – MPC Hospital Provider Authorization Form Package, Point of Contact for Medical Records
Attachment 89 MPC Hospital_MR_AF_Packet.doc
Medical Expenditure Panel Survey - Household and Medical Provider Components
Attachment 89 – MPC Hospital Provider Authorization Form Package, Point of Contact for Medical Records
OMB: 0935-0118
OMB.report
HHS/AHRQ
OMB 0935-0118
ICR 202401-0935-001
IC 191105
Attachment 89 – MPC Hospital Provider Authorization Form Package, Point of Contact for Medical Records
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⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0935-0118 can be found here:
2024-07-02 - Revision of a currently approved collection
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