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 DHS 1139 INSTRUCTIONS for NEW PROVIDERS Med Med Quest 2013-2023

DHS 1139 INSTRUCTIONS for NEW PROVIDERS Med Med Quest 2013-2023

Use a 1139 new med form 2013 template to make your document workflow more streamlined.

Department Of Human Services Med-QUEST Division Health Care Services Branch P. O. Box 700190 Kapolei Hawaii 96709-0190 NON-EMERGENCY GROUND TRANSPORTATION TAXI CABS ATTACHMENT I/We hereby certify and agree that all providers representatives or agents of the individual/organization indicated here in this Attachment for the provision of transportation services or any other service under this agreement is informed that payments are made from Federal and State funds. All individuals covered or in...
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