PASRR Level 1 Screening Form - TMHP
PASRR Level 1 Screening, August, 2021, V.3 . Page 1 of 12 DLN Individual A0800. Position/Title A0400. Provider No. A0200C. State. PASRR Level 1 Screening. A0600. Date of Assessment A0700A. First Name A0700B. Middle Initial A0200B. City A0200D. ZIP Code A0500. Vendor No. A0300. NPI/API A0510. County A0700C. Last Name A0700D. Suffix A0900A. Type ...
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Section A - TMHP
www.tmhp.comPASRR Level 1 Screening, September, 2017, V.2. Page 1 of 12 DLN Individual A0800. Position/Title A0400. Provider No. A0200C. State. PASRR Level 1 Screening
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