Get the free MDCH Form #1355 - Final version Feb 13 2007.doc
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Michigan Adult HIV Confidential Case Report Formed DATE ENTERED:(Patients 13 years of age at time of diagnosis)I. HEALTH DEPT USE ONLY Document Sounded Overreport StatusMI00NewDocument Sourcebook
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What is mdch form 1355?
mdch form 1355 is a document used by the Michigan Department of Community Health to collect information on certain healthcare services.
Who is required to file mdch form 1355?
Healthcare providers and facilities that provide the specified services are required to file mdch form 1355.
How to fill out mdch form 1355?
mdch form 1355 can be filled out manually or electronically with all required information regarding the healthcare services provided.
What is the purpose of mdch form 1355?
The purpose of mdch form 1355 is to track and monitor healthcare services provided in the state of Michigan.
What information must be reported on mdch form 1355?
Information such as the type of healthcare service provided, the provider/facility information, and the number of patients served must be reported on mdch form 1355.
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