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 INSTRUCTIONS DHS 1139E Rev Med Quest 2008-2023

INSTRUCTIONS DHS 1139E Rev Med Quest 2008-2023

Use a INSTRUCTIONS DHS 1139E Rev Med quest 2008 template to make your document workflow more streamlined.

INSTRUCTIONS DHS 1139E (Rev. 08/10) NURSING FACILITY ATTACHMENT PURPOSE: Form DHS 1139E shall be used by health care facilities who provide nursing facility services. This form shall be submitted with a completed DHS 1139, Medicaid Application/Change Request Form. INSTRUCTIONS: 1. Print Name of Provider: Self-explanatory 2. Signature: Self-explanatory 3. Date Signed: Self-explanatory ...
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