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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICESForm Approved OMB No. 09381197PATIENTS REQUEST FOR MEDICAL PAYMENT IMPORTANT: PLEASE READ THE ATTACHED INSTRUCTIONS
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Anyone who requires or is eligible to receive medical assistance or services related to the 1490-patients program may need to submit a get 1490-patients request form. This could include individuals with specific medical conditions, those seeking financial assistance for medical expenses, or anyone needing access to specialized healthcare programs provided through the 1490-patients initiative.
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The 1490-patients request is used to gather information regarding patients who are receiving specific healthcare services under certain programs.
Healthcare providers and facilities that participate in certain government assistance programs are required to file the 1490-patients request.
To fill out the 1490-patients request, one must provide accurate patient information, service details, and ensure all required fields are completed according to the guidelines.
The purpose of the 1490-patients request is to collect data for funding, tracking healthcare services, and ensuring compliance with healthcare regulations.
The information that must be reported includes patient identification details, service dates, types of care, and any relevant medical information.
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