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 Doh 4220 2013

Medicaid Ny Application 2013-2025 Form

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Instructions and help about doh 4220 form

this is your health information management professional today we will be completing the New York State Department of Health authorization for release of health information this form you could download directly by visiting health.ny.gov so go ahead and begin by providing your patient information so Beginning by your patient name you're going to go ahead and provide your first last name and if you do have a middle name it would be nice to include it if you have had a legal name change and for example the facility had you down as Mary Joe you want to go ahead and put in also known as Mary Smith All right so then you want to go ahead and provide us with your date of birth then your patient identification number some people feel free to provide their social number or or if you have a medical record number or encounter number that you utilize at that facility you could go ahead and provide that information however you can skip this part if you don't know it okay and you don&a

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