Get Dd Form 2161
Program, are described on the CHAMPUS claim form. We encourage provider participation. Participating providers should send properly completed claims to: Address of CHAMPUS Send completed consultation Contractor for your area report to: NOTE: Use provided pre-addressed envelope for return of consultation report. (2) If you elect not to participate in the CHAMPUS program, please give the patient an itemized statement of your services, including diagnostic information (ICDA or DSM II is acceptabl.
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