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Get CMS 847 2005

the best of my knowledge, and I understand that any falsification, omission, or concealment of material fact in that section may subject me to civil or criminal liability. PHYSICIAN’S SIGNATURE_________________________________________________________________________ DATE _____/_____/_____ Form CMS-847 (09/05) EF 08/2006 INSTRUCTIONS FOR COMPLETING THE CERTIFICATE OF MEDICAL NECESSITY FOR OSTEOGENESIS STIMULATORS (CMS-847) SECTION A: (May be completed by the supplier) CERTIFICATION TYPE/D.

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