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MI BHS-EMS-0092 2016 free printable template

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MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES EMS SECTION PO BOX 30207 LANSING, MI 48909 (517) 2413026 CERTIFICATE OF INSURANCE/COVERAGE FOR LIFE SUPPORT AGENCIES (Authority: Act 368 of P.A. of
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MI BHS-EMS-0092 is a form used for reporting specific data related to behavioral health and emergency medical services in Michigan.
Entities providing behavioral health services or emergency medical services in Michigan are typically required to file MI BHS-EMS-0092.
To fill out MI BHS-EMS-0092, follow the instructions provided with the form, ensuring all required sections are completed accurately and all necessary data is included.
The purpose of MI BHS-EMS-0092 is to collect data that helps with the analysis and improvement of behavioral health and emergency medical services in Michigan.
The information that must be reported includes patient demographics, types of services provided, and outcomes of the services rendered.
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1978 MICHIGAN BHS certifies subscribing subscribed procured amended herein Rotary EMS LANSING EXPIRATION winged furnished residual participating provider entity

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