Policy and Procedure Template - CCAHN
ATTESTATION OF MEDICAL RECORD LOSS OR DESTRUCTION. Telephone: 573-751-3399. Fax: 573-526-4375. Section I: Instructions. Please complete the information in the sections below, sign and return the attestation to the address below: Missouri Medicaid Audit and Compliance. P.O. Box 6500. Jefferson City, MO 65102. Section II: Provider Information ................
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