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CCP PROVIDER AGREEMENT State Form 50041 (R5 / 414)Indiana State Department of Health Breast and Cervical Cancer Programs a participating provider in the Indiana Breast and Cervical Cancer Program
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The Indiana State Department of Health.
Healthcare facilities and providers in Indiana.
By completing the required forms and submitting them online or by mail.
To collect and monitor health data in the state of Indiana.
Patient demographic information, diagnoses, treatments, and outcomes.
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