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NH Department of Health and Human Services DHHS Division of Family Assistance DFA DFA Form 720 02/13 rev 1/15 DETERMINATION OF INCAPACITY STATUS Name Return Completed Form to Centralized Scanning Unit CSU P.

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What is form 720 dhhs?

Form 720 DHHS is a reporting form used by healthcare providers to disclose financial relationships with certain entities as mandated by the Department of Health and Human Services (DHHS).

Who is required to file form 720 dhhs?

Healthcare providers who meet the criteria set by the DHHS are required to file form 720 DHHS. These criteria may include certain types of financial relationships with covered entities.

How to fill out form 720 dhhs?

To fill out form 720 DHHS, healthcare providers need to review the instructions provided by DHHS and provide accurate and complete information regarding their financial relationships with covered entities.

What is the purpose of form 720 dhhs?

The purpose of form 720 DHHS is to enable DHHS to monitor and track financial relationships between healthcare providers and covered entities, ensuring transparency and compliance with relevant regulations.

What information must be reported on form 720 dhhs?

Form 720 DHHS requires healthcare providers to report specific details about their financial relationships with covered entities, such as the nature of the relationship, the value of the arrangement, and any potential conflicts of interest.

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