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Signature of Initiating/Admitting Staff Valid for 72 hours Signature of Physician/Licensed Psychologist BMS Provider Manual Chapter 503 Behavioral Health Rehabilitation Services Date Page 2. Residential Children s Services Therapeutic Behavioral Services Transportation Services Other I certify that the services for the above-named individual are medically necessary and appropriate. Any change or extension in services indicated above will be authorized in an individualized service plan or...
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Appendix 503a is a form used for reporting certain information to relevant authorities.
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