Transcription of Georgia Department of Community Health
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Georgia Department of Community Health
Date PostedForm NameSizeDate June 23 2003 ADA Dental FormFile Size (58k)Date September 23 2005 Additional Location Application Form and InstructionsFile Size (256k)Date April 01 2003 Anesthesia Base UnitsFile Size (60k)Date June 23 2003 Attachment FormFile Size (67k)Date June 26 2008 Atypical Antipsychotic Prior Authorization FormFile Size (57k)Date August 12 2008 COB Carrier Listing AlphaFile Size (479k)Date August 12 2008 COB Carrier Listing NumericFile Size (506k)Date July 20 2006 COB Reference GuideFile Size (103k)Date May 01 2003 Disclosure of Ownership and Control Interest StatementFile Size (77k)Date October 23 2006 DMA 285: Third-Party Liability QuestionnaireFile Size (20k)Date January 10 2005 DMA 6 PhysicianG\xC7\xD6s Recommendation For Nursing Facility CareFile Size (64k)Date June 23 2003 DMA-276: Acknowledgement of Prior Receipt of Hysterectomy File Size (59k)Date June 23 2003 DMA-292: Request for FormsFile Size (97k)Date May 19 2004 DMA-311: Certification of Necessity for Abortion File Size (19k)Date May 01 2006 DMA-312: COB/TPL Accident Information ReportFile Size (17k)Date February 26 2007 DMA-322 Exceptional Transportation Prior Authorization RequestFile Size (221k)Date March 15 2005 DMA-380 Optical Device PrescriptionFile Size (70k)Date February 08 2005 DMA-410: COB Notification FormFile Size (132k)Date June 03 2004
Date February 22 2008 SXC 835 Payment Advice Request Form File Size (27k) Date March 26 2008 SXC Payer Specification Sheet File Size (72k) Date October 01 2007 SXC Provider Portal Registration Form File Size (79k) Date September 14 2007 Synagis Order Form File Size (155k) Date November 23 2004 TEFRA/Katie Beckett Care Plan Application File Size ...
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