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Get and Sign ICFIID PHYSICIAN CERTIFICATION and RECERTIFICATION 2017-2022 Form
Institutional claims utilizing the certifying physician information in the claim under the attending physician section. Provider Name Address RECIPIENT INFORMATION Recipient Name Provider NPI City State ZIP Code Certification Period MM/DD/YYYY From To CERTIFYING PHYSICIAN INFORMATION Certifying or Attending Physician Name Physician NPI PHYSICIAN SIGNATURE Includes a Doctor of Osteopathy physician s assistant or nurse practitioner acting within their scope of authority and under the direction of...Show details
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