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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DMS-846
for the current year.
Form DMS-846 Practice Withdrawal Form - Arkansas Patient-Centered Medical Home Program - Arkansas
What Is Form DMS-846?
This is a legal form that was released by the Arkansas Department of Human Services - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the Form DMS-846?
A: The Form DMS-846 is a practice withdrawal form.
Q: What is the Arkansas Patient-Centered Medical Home Program?
A: The Arkansas Patient-Centered Medical Home Program is a program in Arkansas that promotes comprehensive, coordinated, and patient-centered care.
Q: How do I use the Form DMS-846?
A: You can use the Form DMS-846 to request withdrawal from the Arkansas Patient-Centered Medical Home Program.
Q: Who should use the Form DMS-846?
A: The Form DMS-846 should be used by healthcare practices that wish to withdraw from the Arkansas Patient-Centered Medical Home Program.
Form Details:
- Released on February 1, 2018;
- The latest edition provided by the Arkansas 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 DMS-846 by clicking the link below or browse more documents and templates provided by the Arkansas Department of Human Services.
