Form DHS-7120F-ENG Early Intensive Developmental and Behavioral Intervention (Eidbi) Level Iii Provider Assurance Statement - Minnesota Health Care Programs (Mhcp) - Minnesota

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What Is Form DHS-7120F-ENG?

This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the DHS-7120F-ENG form?
A: The DHS-7120F-ENG form is the Early Intensive Developmental and Behavioral Intervention (Eidbi) Level Iii Provider Assurance Statement for Minnesota Health Care Programs (Mhcp) in Minnesota.

Q: What does Eidbi Level III refer to?
A: Eidbi Level III refers to the highest level of Early Intensive Developmental and Behavioral Intervention services.

Q: What is the purpose of the Provider Assurance Statement?
A: The Provider Assurance Statement is used to ensure that providers of Eidbi Level III services comply with the requirements of the Minnesota Health Care Programs.

Q: Who needs to complete the Provider Assurance Statement?
A: Providers of Eidbi Level III services in Minnesota Health Care Programs need to complete the Provider Assurance Statement.

Q: What are Minnesota Health Care Programs?
A: Minnesota Health Care Programs refer to the various healthcare programs and services available to residents of Minnesota.

Form Details:

Released on August 1, 2021;
The latest edition provided by the Minnesota 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 DHS-7120F-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.