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Please print, complete this form, and mail it via USPS to the address above. (Please print clearly)SECTION A: Recipient InformationMDCAPS #: ___Social Security #: ___ ___ ___ ___ ___ ___ ___ ___ ___
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The RFA cover page with HSCRC is a form used for submitting requests for approval from the Health Services Cost Review Commission (HSCRC) in Maryland. It serves as an introductory document summarizing the key details of the request.
Healthcare providers, hospitals, and healthcare organizations that are seeking approval for changes in service provision, rates, or other operational adjustments are required to file the RFA cover page with HSCRC.
To fill out the RFA cover page, applicants need to provide information such as the requestor's details, a brief description of the proposed changes, relevant financial data, and any supporting documentation required by the HSCRC.
The purpose of the RFA cover page is to provide the HSCRC with a concise summary of a request, ensuring that all necessary information is included for the review and approval process.
The RFA cover page must report information such as the name of the facility, contact information, the nature of the request, financial implications, and other relevant details to facilitate the review process.
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