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1568005809 PURE HEALTHCARE OF IDAHO LLC National Provider Identifiers Registry The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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This form is a documentation of healthcare services provided.
Healthcare providers and facilities are required to file this form.
The form must be filled out with details of the healthcare services provided.
The purpose is to document and report healthcare services for record-keeping and regulatory compliance.
Details such as patient information, type of service provided, date of service, and healthcare provider information must be reported.
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