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Influenza-Associated Pediatric Mortality Case Report Form Approved OMB No. 0920-0004 STATE USE ONLY DO NOT SEND INFORMATION IN THIS SECTION TO CDC Last Name: Address: First Name: County: City: State,

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1. Individuals applying for a specific program or service: The 0920-0004 exp - azdhs form may be required for individuals applying for a particular program or service provided by the AZDHS (Arizona Department of Health Services). This could include applications for healthcare programs, licenses, permits, or other services.
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What is 0920-0004 exp - azdhs?

0920-0004 exp - azdhs is a form used for reporting certain public health data to the Arizona Department of Health Services (AZDHS).

Who is required to file 0920-0004 exp - azdhs?

Healthcare facilities, providers, and other entities as specified by AZDHS are required to file 0920-0004 exp - azdhs.

How to fill out 0920-0004 exp - azdhs?

You can fill out 0920-0004 exp - azdhs electronically through the AZDHS online portal or by submitting a paper form as per the instructions provided by AZDHS.

What is the purpose of 0920-0004 exp - azdhs?

The purpose of 0920-0004 exp - azdhs is to collect and analyze public health data to monitor and improve the health outcomes of the population in Arizona.

What information must be reported on 0920-0004 exp - azdhs?

Information such as disease surveillance data, immunization rates, birth and death statistics, and other public health indicators must be reported on 0920-0004 exp - azdhs.

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