Dhs Provider Agreement Form

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The following table contains links to the corresponding vendor registration forms for each vendor type. As of August 1, 2018, the provider may need to call the Office of Medical Assistance Programs, Provider Enrollment at 1-800-537-8862 to request a paper application when the PDF version of the application is no longer published on the DHS Provider Enrollment website. Paper applications continue to be accepted for processing. *FQHC Requirements / Additional Information *RHC Requirements / Additional Information * Non-FQHC/RHC Clinical Requirements / Additional Information *All login documents are in Adobe PDF format. You must have a copy of Adobe Acrobat Reader installed on your system to view it. Online Application * Requirements / Additional Information / Online Application Forms * Medically Fragile Care Services Requirements Online Requirements * Medical Requirements * Medical Requirements * Maternal-Fetal Specialist Online-Bewerbung Telemedicine * Midlevel Practitioner Requirements. . . * Acute Hospital * Emergencies * Requirements for Short Procedure Units * Hospital Psychiatric Care * Inpatient Alcohol and Drugs Medical Rehabilitation * Hospital Medical Rehabilitation * JCAHO Certified RTF (Residential Treatment Facility) * State Recognized Health Center * Rural Health Clinic * Non-FQHC/RHC 11 Clinics – Mental Health Providers / Drug Abuse * Requirements for Mental Health Provider / Drug Abuse * Requirements for Social Workers. .

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