![]() , Application for Emergency Examination and Treatment (MH-2 Application MS Word). Make sure if your document is double-sided, you scan both sides. if the individual is committed or discharged by court, I wish to be notified using the contact. Processing the admission paperwork accurately and efficiently is crucial for maintaining complete and organized patient records. For industry information about COVID-19, visit our COVID-19 medical devices section.Īpplication forms listed below must accompany medical device applications filed by a manufacturer or sponsor. Provider Service Authorization Inquiry Form. Fax - Documents may be faxed to the following numbers. (Hospital staff use form IL462-2203 for notification purposes).
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