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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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  3. Enter your official identification and contact details.
  4. Apply a check mark to indicate the choice wherever needed.
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  8. Now it is possible to print, save, or share the document.
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