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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 Form DMS-846?
A: Form DMS-846 is a Practice Withdrawal Form for the Arkansas Patient-Centered Medical Home Program.
Q: What is the Arkansas Patient-Centered Medical Home Program?
A: The Arkansas Patient-Centered Medical Home Program is a program that aims to improve the quality of primary care services in Arkansas.
Q: Who can use Form DMS-846?
A: Healthcare practices participating in the Arkansas Patient-Centered Medical Home Program can use Form DMS-846 to withdraw from the program.
Q: Why would a practice use Form DMS-846 to withdraw from the program?
A: A practice may use Form DMS-846 to withdraw from the program if they no longer wish to participate or if they are no longer eligible.
Form Details:
- Released on October 1, 2021;
- 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.
