Get CA Optum Facility Cred App 2014
review be conducted to ensure that your application fully complies with all instructions. Failure to complete the application thoroughly could result in the delay of your credentialing process. 1 PAGES 2-6: ALL applicants must complete thoroughly. Page 6 must be signed by the individual authorized to attest to the information submitted on behalf of the entity. Please enter the date and identify the name of the individual authorized to attest to the information submitted on behalf of the .
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- Include the date to the sample using the Date feature.
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