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DSS-4449B rev.4/97 AH EHP ALP IDENTIFYING DATA NAME OF FACILITY Name ALP MA Start date of Care Home address prior to admission Date of Birth Street Social Security City State Zip Medicaid CIN Admitted From if different from above Medicare Other Health Insurance Co.
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What is doh 4449b?
Doh 4449b is a form used for reporting specific information to the Department of Health (DOH).
Who is required to file doh 4449b?
Entities or individuals specified by the DOH are required to file doh 4449b.
How to fill out doh 4449b?
To fill out doh 4449b, you need to provide the requested information in the designated fields on the form.
What is the purpose of doh 4449b?
The purpose of doh 4449b is to collect and document specific data as required by the DOH.
What information must be reported on doh 4449b?
The specific information that must be reported on doh 4449b will be outlined in the form instructions provided by the DOH.
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