DENTAL_APPENDIX_A.PDF

Published: 04/17/2019

Description

IHS 199-1 (REV. 01/89) PATIENT REFERRAL NOTICE INSTRUCTIONS (This form may be used by Medical, Dental, and Paramedical personnel to refer DIR Beneficiaries for medical, dental or related services.) 1. TO (Name, title, and address of person or orga...

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