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NEW YORK STATE DEPARTMENT OF HEALTH Medicaid Health Home Patient Information Sharing Consent Name of Health Home By signing this form, you agree to be in the Health Home. To be in a Health Home, health
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What is doh 5058?
doh 5058 is a form used for reporting certain information to the Department of Health.
Who is required to file doh 5058?
Healthcare providers and facilities are required to file doh 5058.
How to fill out doh 5058?
doh 5058 should be filled out with accurate information as per the instructions provided by the Department of Health.
What is the purpose of doh 5058?
The purpose of doh 5058 is to collect specific data for monitoring and regulating healthcare practices.
What information must be reported on doh 5058?
Information such as patient demographics, services provided, and any potential risks must be reported on doh 5058.
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