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Health Financial Systems
IU HEALTH BLACKFOOT HOSPITAL
In Lieu of Form CMS255210
This report is required by law (42 USC 1395g; 42 CFR 413.20(b)). Failure to report can result in all interim FORM APPROVED
payments
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How to fill out iu health blackford hospital
How to fill out iu health blackford hospital
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03
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What is iu health blackford hospital?
IU Health Blackford Hospital is a healthcare facility located in Hartford City, Indiana.
Who is required to file iu health blackford hospital?
Patients who have received services at IU Health Blackford Hospital may be required to provide information for filing purposes.
How to fill out iu health blackford hospital?
Patients can fill out IU Health Blackford Hospital forms either online or in person at the hospital.
What is the purpose of iu health blackford hospital?
The purpose of IU Health Blackford Hospital is to provide healthcare services to the community.
What information must be reported on iu health blackford hospital?
Information such as patient demographics, medical history, insurance information, and treatment received must be reported on IU Health Blackford Hospital forms.
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