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ACTION: Originate: 01/13/2017 3:21 Rule Summary and Fiscal Analysis (Part A) Ohio Department of Medicaid Agency NameTommi Potter DivisionContact50 Town St 4th floor Columbus OH 43218270961475238776149951301Agency

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How to fill out 5160-9-06 amendment - register

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Obtain a copy of form 5160-9-06 amendment - register

02

Fill out all required information on the form, including name, address, and any applicable amendments

03

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04

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Healthcare facilities that are required to make amendments to their registration information

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