Get the free Instruction for form DHS 3096. Federally Qualified Health Centers and Rural Health C...
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State of CaliforniaHealth and Human Services AgencyDepartment of Health Care ServicesINSTRUCTIONS FOR MEDICAL FEDERALLY QUALIFIED HEALTH CENTER (FHC)/RURAL HEALTH CLINIC (RHC) PROSPECTIVE PAYMENT
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8. Make copies of the completed form and any supporting documents for your records.
9. Submit the instruction form and any required documents to the designated authority as instructed.
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