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PARTICIPANT APPLICATION West Central Indiana Chrysalis Community Open to High School Sophomores, Juniors & Seniors (age 1518) and Collegiate (1923 unmarried) Applicants Please print legibly and complete
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What is p a r t?
P A R T stands for Provider Access Request Form.
Who is required to file p a r t?
Healthcare providers are required to file p a r t.
How to fill out p a r t?
You can fill out P A R T by providing all the required information and submitting it to the appropriate governing body.
What is the purpose of p a r t?
The purpose of P A R T is to request access to a patient's healthcare information.
What information must be reported on p a r t?
On P A R T, you must report details about the patient, the provider requesting access, and the reason for the request.
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