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SOUTHERN INDIAN HEALTH COUNCIL, INC. 4058 Willows Road Alpine, CA 91901 phone (619) 4451188 fax (619) 6593144 www.SIHC.orgFinancial Agreement Patient Name: Date of Birth: / / Be advised that all patients
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About ussouformrn Indian Health is a form that provides information about the healthcare services provided to Native American/Alaska Native individuals by the Indian Health Service or tribal health programs.
Healthcare providers who provide services to Native American/Alaska Native individuals through the Indian Health Service or tribal health programs are required to file about ussouformrn Indian Health.
About ussouformrn Indian Health can be filled out electronically or on paper. Providers must report information such as patient demographics, services provided, and payment details.
The purpose of about ussouformrn Indian Health is to track the healthcare services provided to Native American/Alaska Native individuals and ensure proper reimbursement for those services.
Providers must report information such as patient demographics, services provided, payment details, and any other relevant information about the healthcare services provided.
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