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ALABAMA MEDICAID AGENCY PRIOR REVIEW AND AUTHORIZATION REQUEST Rehab Option DAYS () DM HMI () DM HSA () Servicing State Agency NPI # Provider Information:Recipient Information:Servicing Provider NPI:
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What is 9414paformbhrehab9-1-17doc?
9414paformbhrehab9-1-17doc is a specific form used for reporting certain information related to rehabilitation services.
Who is required to file 9414paformbhrehab9-1-17doc?
Providers of rehabilitation services are required to file 9414paformbhrehab9-1-17doc.
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9414paformbhrehab9-1-17doc must be filled out with accurate information regarding the rehabilitation services provided.
What is the purpose of 9414paformbhrehab9-1-17doc?
The purpose of 9414paformbhrehab9-1-17doc is to report and document rehabilitation services provided.
What information must be reported on 9414paformbhrehab9-1-17doc?
Information regarding the type and quantity of rehabilitation services provided must be reported on 9414paformbhrehab9-1-17doc.
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