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 Open PDF File, 72 29 KB, for RY2021 Hospital Quality Contact Form 2021-2023

Open PDF File, 72 29 KB, for RY2021 Hospital Quality Contact Form 2021-2023

Use a Open PDF File, 72 29 KB, For RY2021 Hospital Quality Contact Form template to make your document workflow more streamlined.

Name MassHealth NHSN Contact Name Data Vendor User Name Agency Key Representative Signature Date Signed MAILING INSTRUCTION Please mail the completed form with a typed cover letter on hospital stationery to the address shown on the right. Print Clear form RY2021 MassHealth Acute Hospital Pay-for-Performance Program Hospital Quality Contacts Form INSTRUCTIONS Pursuant to the Acute Hospital RFA Section 7 each hospital must complete and submit information on staff involved in quality reporting...
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