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MI MMP 3502 2013-2025 free printable template

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MMP 3502 (Rev. 4/13) FOR OFFICIAL USE ONLY Department of Licensing and Regulatory Affairs Michigan Medical Marijuana Registry P.O. Box 30083, Lansing, MI 48909 517-373-0395 www.michigan.gov/mmp **CHANGE
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How to fill out MI MMP 3502

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Start by downloading the MI MMP 3502 form from the official Michigan government website.
02
Read the instructions carefully before filling out the form.
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Fill in your personal information, including your name, address, and contact details.
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Provide the required details about your medical condition or circumstances.
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Include any necessary supporting documentation as specified in the instructions.
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Review the information for accuracy and completeness before submitting.
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Submit the completed form through the preferred method indicated in the instructions (online, by mail, etc.).

Who needs MI MMP 3502?

01
Individuals who are applying for medical assistance or related services in Michigan.
02
Healthcare providers submitting a request for specific medical programs on behalf of their patients.
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MI MMP 3502 is a form used in Michigan for reporting specific medical and financial data by healthcare providers and facilities within the state's Medicaid program.
Healthcare providers and facilities that participate in the Medicaid program in Michigan are required to file MI MMP 3502.
To fill out MI MMP 3502, providers must complete each section of the form accurately, ensuring that all required information is provided, and submit it to the designated state authority, following the specific submission guidelines provided.
The purpose of MI MMP 3502 is to collect necessary data for the state of Michigan to monitor, evaluate, and manage Medicaid services effectively and efficiently.
MI MMP 3502 requires reporting of patient demographics, service details, provider information, and financial data relevant to the services rendered under the Medicaid program.
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