This version of the form is not currently in use and is provided for reference only. Download this version of Form DHS-3535-ENG for the current year.

Form DHS-3535-ENG Individual Practitioner - Mhcp Provider Profile Change Form - Minnesota

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What Is Form DHS-3535-ENG?

This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the DHS-3535-ENG?
A: The DHS-3535-ENG is the Individual Practitioner - MHCP Provider Profile Change Form for Minnesota.

Q: What is the purpose of the form?
A: The purpose of the form is to allow individual practitioners to make changes to their MHCP provider profile in Minnesota.

Q: Who can use this form?
A: This form can be used by individual practitioners who are enrolled as MHCP providers in Minnesota.

Q: What changes can be made using this form?
A: This form allows for changes to personal information, contact information, practice locations, services provided, and other related details.

Form Details:

Released on January 1, 2012;
The latest edition provided by the Minnesota Department of Human Services;
Easy to use and ready to print;
Quick to customize;
Compatible with most PDF-viewing applications;
Fill out the form in our online filing application.

Download a fillable version of Form DHS-3535-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.