D4_ORDER_FOR_HEALTH_SERVICES,_IHS-843-1A.PDF

Published: 02/03/2017

Description

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE ORDER FOR HEALTH SERVICES Instructions to complete the order and claim submission on reverse side of Original form. Order Provisions and Clauses on Copy 3 - Provider 1. ORDER NO. ...

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