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DEPARTMENT OF HEALTH SERVICES STATE OF WISCONSIN Division of Long Term Care 42 CFR 431.107 F00180B (02/2014) WISCONSIN MEDICAID PROGRAM PROVIDER AGREEMENT AND ACKNOWLEDGEMENT OF TERMS OF PARTICIPATION
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Acknowledgement of terms is a document that confirms understanding and agreement with specified terms.
Any individual or entity who agrees to certain terms and conditions may be required to file acknowledgement of terms.
Acknowledgement of terms can typically be filled out by signing and dating the document to confirm agreement with the specified terms.
The purpose of acknowledgement of terms is to formally acknowledge understanding and agreement with specific terms and conditions.
The information reported on acknowledgement of terms may include name, date, signature, and any specific terms being acknowledged.
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