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Filled Attestation Form Sample

Filled Attestation Form Sample

Create a custom attestation form 0 that meets your industry’s specifications.

Under 42 CFR 413.65 in relation to hospitals are not made for the following facilities: ambulatory surgical centers (ASCs), comprehensive outpatient rehabilitation facilities (CORFs), home health agencies (HHAs), skilled nursing facilities (SNFs), hospices, inpatient rehabilitation units that are excluded from the inpatient prospective payment system for acute hospital services, independent diagnostic testing facilities furnishing only services paid under a fee schedule (subject to...
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  1. To get started on the form, use the Fill camp; Sign Online button or tick the preview image of the blank.
  2. The advanced tools of the editor will direct you through the editable PDF template.
  3. Enter your official identification and contact details.
  4. Apply a check mark to indicate the choice wherever needed.
  5. Double check all the fillable fields to ensure complete accuracy.
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  7. Press Done after you complete the form.
  8. Now it is possible to print, save, or share the document.
  9. Follow the Support section or get in touch with our Support team in case you have any questions.

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