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Forms and Appendices
Notice of Community Service Obligation (CHFCLI)
State Medicaid Excluded Provider List
CMS State Medicaid Director Letter
List of Miscellaneous Licenses
Summary of Significant Factors Determining the Permissibility of Participation in Partnership
Sample Disclosure Regarding Ambulance Replenishing
Conflict of Interest Certification Form
Acknowledgment of Receipt of Hospital Compliance Plan
Model Hospital Compliance Plan
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