PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
the document
for the current year.
Coversheet for Email or Fax Provider Enrollment - North Dakota
Coversheet for Email or Fax Provider Enrollment is a legal document that was released by the North Dakota Department of Health and Human Services - a government authority operating within North Dakota.
FAQ
Q: What is the Coversheet for Email or Fax Provider Enrollment?
A: The Coversheet for Email or Fax Provider Enrollment is a form used for enrolling a provider in North Dakota.
Q: Who needs to fill out the Coversheet for Email or Fax Provider Enrollment?
A: Providers who want to enroll in North Dakota and receive email or fax communications need to fill out this form.
Q: What is the purpose of the Coversheet for Email or Fax Provider Enrollment?
A: The purpose of this form is to collect the necessary information to communicate with providers via email or fax.
Q: Is the Coversheet for Email or Fax Provider Enrollment specific to North Dakota?
A: Yes, this form is specific to North Dakota and is used for enrolling providers in the state.
Form Details:
- Released on September 6, 2019;
- The latest edition currently provided by the North Dakota Department of Health and Human Services;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health and Human Services.
