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Get the free MMA SRC #12, Attachment 4: Network Practitioner Credentialing and ...

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Regional Physician NetworkAnnual Attestation Name: ___Date: ___Relationship to the RPN (name of practice group): ___ 1. Standards of Conduct I have received a copy of the Runs Standards of Conduct.
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MMA SRC 12 attachment is a form used to report certain information related to financial transactions.
Entities or individuals engaged in certain financial transactions are required to file MMA SRC 12 attachment.
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The purpose of MMA SRC 12 attachment is to provide relevant financial information to the authorities.
Information such as transaction details, amounts, dates, and parties involved must be reported on MMA SRC 12 attachment.
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