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Get and Sign Impa Iowa 2012-2022 Form

Get and Sign Impa Iowa 2012-2022 Form

Get the impa iowa 2012 template, fill it out, eSign it, and share it in minutes.

Home) Name: Phone Number: Email Address: IMPA User Name: The utilization of IMPA (referenced in Section 4 of the Health Home Provider Agreement) involves a resource (Health Home staff member) that will login and request Health Home enrollment of qualifying patients from the practice. This form will be reviewed and approved or denied and an e-mail will be sent as soon as the process is completed to the address listed on the form. Signature: Date: Questions in completing this form contact:...
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