OK HealthChoice Network Facility Additional Location Form 2018-2025 free printable template
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Oklahoma
Department
of Rehabilitation
ServicesDOCDepartment of
Corrections
OklahomaNETWORK FACILITY ADDITIONAL LOCATION FORM
Facility Name:
Specialty:Medicare Number:Federal Tax ID Number:NPI#:
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How to fill out OK HealthChoice Network Facility Additional Location
How to fill out OK HealthChoice Network Facility Additional Location Form
01
Obtain the OK HealthChoice Network Facility Additional Location Form from the official website or your local health department.
02
Fill in the facility's name and address in the designated sections.
03
Provide the contact information for the facility, including phone number and email address.
04
List the services offered at the additional location.
05
Include the name and credentials of the facility administrator or contact person.
06
Sign and date the form at the designated area.
07
Submit the completed form to the appropriate health authority or network administration.
Who needs OK HealthChoice Network Facility Additional Location Form?
01
Healthcare facilities that wish to expand their services to additional locations within the HealthChoice network.
02
Providers or organizations seeking to maintain compliance with health regulations.
03
Current HealthChoice network participants adding new physical sites for patient care.
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What is OK HealthChoice Network Facility Additional Location Form?
The OK HealthChoice Network Facility Additional Location Form is a document used to report and register additional locations of healthcare facilities that participate in the OK HealthChoice Network.
Who is required to file OK HealthChoice Network Facility Additional Location Form?
Healthcare facilities that are part of the OK HealthChoice Network and wish to add new locations must file the OK HealthChoice Network Facility Additional Location Form.
How to fill out OK HealthChoice Network Facility Additional Location Form?
To fill out the form, provide the required information about the new facility location, including the facility name, address, contact details, and any other necessary supporting information as specified in the form instructions.
What is the purpose of OK HealthChoice Network Facility Additional Location Form?
The purpose of the form is to ensure that the OK HealthChoice Network has accurate and up-to-date information about all facility locations that provide services to its members.
What information must be reported on OK HealthChoice Network Facility Additional Location Form?
The form must report information such as the facility name, address, type of services provided, contact information, and any other relevant details as required by the network.
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