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STATE OF MARYLAND
DEPARTMENT OF HEALTH AND MENTAL HYGIENE (DHH)
OFFICE OF HEALTH CARE QUALITY (ONCE)Form Approved
4/17/13 DHH Form
AC APP 1 1 IN SAS 3AMBULATORY CARE: RESIDENTIAL SERVICE AGENCY (RSA)
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What is 41713 dhmh form?
The 41713 dhmh form is a report form used to collect information related to healthcare services.
Who is required to file 41713 dhmh form?
Healthcare providers and facilities are required to file the 41713 dhmh form.
How to fill out 41713 dhmh form?
The 41713 dhmh form can be filled out manually or electronically following the instructions provided by the Department of Health and Mental Hygiene (DHMH).
What is the purpose of 41713 dhmh form?
The purpose of the 41713 dhmh form is to collect data on healthcare services provided by facilities and providers.
What information must be reported on 41713 dhmh form?
The 41713 dhmh form requires information such as patient demographics, services provided, and billing information.
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