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MAP374 (Rev. 9/02) Election of Medicaid Hospice Benefit I, elect to (Patient Name/MAID#) receive the Medicaid Hospice Benefit from (Facility Name) (Provider Number) this day of, 20. I am aware that
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How to fill out map 374 - chfs
How to fill out map 374
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Start by opening map 374 on your computer or mobile device.
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What is map 374?
Map 374 is a form used to report information about specific geographic locations.
Who is required to file map 374?
All entities that own or operate the specified locations are required to file map 374.
How to fill out map 374?
Map 374 can be filled out online or submitted in paper form with the required information.
What is the purpose of map 374?
The purpose of map 374 is to provide accurate and up-to-date information about specific geographic locations.
What information must be reported on map 374?
Map 374 must include details such as the location's exact address, coordinates, and any relevant notes or updates.
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