NY PHY 0738 2002 free printable template
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APPROVED OMB-0938-0008 CARRIER
PICA
(FOR PROGRAM IN ITEM 1) 1a. INSURED'S I.D. NUMBER 4. INSURED'S NAME (Last Name, First Name, Middle Initial) SEX M 5. PATIENT'S ADDRESS (No. Street) 6. PATIENT RELATIONSHIP
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How to fill out NY PHY 0738
01
Begin by obtaining the NY PHY 0738 form from the New York State Department of Health website or your local health department.
02
Fill in the required personal information at the top of the form, including your name, address, and contact details.
03
Indicate the type of service or procedure for which you are requesting authorization.
04
Provide details about your medical history relevant to the requested service.
05
Attach any necessary supporting documents, such as medical records or referral letters.
06
Sign and date the form at the designated space.
07
Submit the completed form either by mail or electronically as per the instructions provided.
Who needs NY PHY 0738?
01
Individuals seeking prior authorization for specific medical services in New York.
02
Healthcare providers who need to submit a request for services on behalf of their patients.
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What is NY PHY 0738?
NY PHY 0738 is a form used in New York for the annual reporting of health care provider data, including information about patient care, services provided, and financial performance.
Who is required to file NY PHY 0738?
Health care providers, including hospitals, nursing homes, and certain outpatient facilities in New York, are required to file NY PHY 0738 annually.
How to fill out NY PHY 0738?
To fill out NY PHY 0738, providers must gather relevant data about their services, patient demographics, staffing, and financial information, and then complete each section of the form according to the instructions provided by the state.
What is the purpose of NY PHY 0738?
The purpose of NY PHY 0738 is to collect data that helps the state monitor health care services, improve patient care, and ensure compliance with health regulations and standards.
What information must be reported on NY PHY 0738?
NY PHY 0738 requires reporting on various aspects such as patient demographics, services rendered, staffing levels, financial performance, and any other relevant operational data.
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