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MODEL WAIVERPHYSICIAN REFERRAL FOR INDIVIDUALS AT RISK OF HOSPITALIZATIONIncomplete forms will be returned. Please complete all items. If nonapplicable, insert N/A. Attach extra sheets or supporting
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What is model waiver physician referral?
Model waiver physician referral is a form used to request a waiver of the physician referral requirement for certain health care services.
Who is required to file model waiver physician referral?
Health care providers who are seeking a waiver of the physician referral requirement must file model waiver physician referral.
How to fill out model waiver physician referral?
Model waiver physician referral can be filled out by providing detailed information about the patient, the health care service, and the reason for requesting a waiver of the physician referral requirement.
What is the purpose of model waiver physician referral?
The purpose of model waiver physician referral is to request a waiver of the physician referral requirement for certain health care services.
What information must be reported on model waiver physician referral?
Model waiver physician referral must include information about the patient, the health care service, and the reason for requesting a waiver of the physician referral requirement.
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