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.
Q: What is the OHP3120 Provider Enrollment Attachment?
A: OHP3120 is a form used for provider enrollment attachment specifically for school medical services in Oregon.
Q: Who needs to fill out the OHP3120 form?
A: Healthcare providers offering school medical services in Oregon need to fill out this form.
Q: What information is required on the OHP3120 form?
A: The form requires information such as provider details, service location, billing information, and agreement to comply with program requirements.
Q: Is there a fee for submitting the OHP3120 form?
A: No, there is no fee for submitting the OHP3120 form for provider enrollment attachment.
Form Details:
Download a fillable version of Form OHP3120 by clicking the link below or browse more documents and templates provided by the Oregon Health Authority.