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Form OHA3974 Provider Disclosure Statement of Ownership and Control, Business Transactions and Criminal Convictions - Oregon
What Is Form OHA3974?
This is a legal form that was released by the Oregon Health Authority - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is OHA3974 Provider Disclosure Statement of Ownership and Control?
A: The OHA3974 Provider Disclosure Statement of Ownership and Control is a form used in Oregon to disclose information about the ownership and control of a healthcare provider.
Q: What information is required in the form?
A: The form requires information about the provider's ownership, control, business transactions, and any criminal convictions.
Q: Why is this form important?
A: This form is important for regulatory purposes to ensure transparency and accountability in the healthcare industry.
Q: Who needs to fill out this form?
A: Healthcare providers in Oregon are required to fill out this form.
Form Details:
- Released on September 1, 2019;
- The latest edition provided by the Oregon Health Authority;
- 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 OHA3974 by clicking the link below or browse more documents and templates provided by the Oregon Health Authority.
Download Form OHA3974 Provider Disclosure Statement of Ownership and Control, Business Transactions and Criminal Convictions - Oregon
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