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Get the free PCOG2 Step 3 - Notice of Write off to Provider FINAL April 4 2008.doc

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Site Name Site Address Winnipeg, Manitoba Postal Code Telephone: Fax: INTERNAL MEMO Date: To:(Provider)From:(Designated Admin)Subject: Notice of Outstanding Third Party Billing Re: Invoice # ___ (attached
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How to fill out pcog2 step 3

01
Step 1: Review the instructions for step 3 of the PCOG2 form
02
Step 2: Fill in the required information accurately and legibly
03
Step 3: Double check all information before submitting
04
Step 4: Submit the completed PCOG2 form as instructed

Who needs pcog2 step 3?

01
Healthcare providers who are participating in the PCOG2 assessment process
02
Patients who are being assessed using the PCOG2 tool
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