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Get Final Attestation Of Compliance With Ars 35-196-05.docm - Azahcccs
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How to fill out the Final ATTESTATION OF COMPLIANCE WITH ARS 35-196-05.docm - Azahcccs online
Navigating the Final ATTESTATION OF COMPLIANCE WITH ARS 35-196-05.docm - Azahcccs can be straightforward with clear guidance. This document outlines your responsibilities in attesting compliance and provides step-by-step instructions for completing the form accurately.
Follow the steps to complete the attestation form accurately.
- Press the ‘Get Form’ button to obtain the form and open it in your selected document editor.
- Locate the section where you are required to attest on behalf of the Provider. Clearly state the Provider's name and ensure your authority to make these attestations.
- In the attestation section, affirm that the Provider will not perform abortions unless specific conditions are met. Familiarize yourself with those conditions listed under points a to d.
- If applicable, in section d, provide details on any circumstances and medical conditions justifying an abortion that aligns with A.R.S. 35-196.05(B). Make sure to describe this carefully.
- Note that the Provider is required to inform the AHCCCS Administration within 48 hours if there is any failure to comply with these attestations. Provide the correct address within the document to send this notice.
- Finally, complete the form by signing it, including your printed name, Provider name, title, and Provider ID number.
- After filling in all necessary fields, ensure to save changes to the document. You can then choose to download, print, or share the completed form as required.
Take action now and complete your attestation form online with confidence.
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