
Get Form 5871 2020-2025
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Tips on how to fill out, edit and sign Form 5871 online
How to fill out and sign Form 5871 online?
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Form 5871-S is completed and submitted as a condition of approval or renewal of a Texas Medicaid enrollment application or a contract agreement between the disclosing entity (applicant/provider) and HHSC for any services program. A full and accurate disclosure of ownership and control interest is required.
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