Printable Form 8840 Broken Arrow Oklahoma 2024-2025

Printable Form 8840 Broken Arrow Oklahoma: What You Should Know

Form. To receive approval of the final application, please return this form to the Medical Director with the following info: Medical Director and staff member name(BS), address(BS) and telephone number for the case manager, the patient's medical record number, case number (if applicable) and copy of the patient's final discharge agreement (if applicable). Medical Director name, address and telephone number, If you are an affiliate or parent institution, please attach your Approval of Final Admission Form. Mail this to the address below: Medical Director: Medical Director's name, address, and telephone number, A. From hospital/inpatient: Respiratory Patient Health Status/Status Update. A. Respiratory Patient Health Status/Status Update. To receive approval for the final application, please return this form to the Medical Director with the following info: Medical Director and staff member name(BS), address(BS) and telephone number for the case manager, the patient's respiratory record number and copy of the patient's final discharge agreement (if applicable). Medical Director name, address and telephone number, If you are an affiliate or parent institution, please attach your Approval of Final Admission Form. Mail this to the address below: Medical Director's name, address, and telephone number, B. From hospital/inpatient: Respiratory Patient Health Status/Status Update. B. Respiratory Patient Health Status/Status Update. To receive approval for the final application, please return this form to the Medical Director with the following info: Medical Director and staff member name(BS), address(BS) and telephone number for the case manager, The following information is to be attached on the back: Patient's name (please use a current first and last name, or a combination, and a current middle initial, no abbreviations! I.e., JOHNSON, JOHN), Date of respiratory assessment/evaluation (NOT current, please use date of arrival and stay in hospital) If patient stays longer than 3 days, please also include: Patients medical record number and copy of discharge agreement for all patients for the time period.

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