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BIOGRAPHICAL SKETCH Provide the following information for the key personnel and other significant contributors in the order listed on Form Page 2. Follow this format for each person. DO NOT EXCEED
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PHS 416-1H Rev 602 is a reporting form used by healthcare providers to submit information related to the services they offer under certain federal health programs.
Healthcare providers who participate in federally funded health programs or receive federal grants are required to file PHS 416-1H Rev 602.
To fill out PHS 416-1H Rev 602, providers must gather required information about their services, patient demographics, and any relevant performance metrics, then complete the form according to the provided instructions.
The purpose of PHS 416-1H Rev 602 is to collect standardized data that helps in monitoring, evaluating, and improving federally funded health services and programs.
The form requires reporting information such as service types, patient demographics, service utilization data, and performance outcomes.
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