Office of the Deputy Secretary for Administration Forms and Office Locations – Government Agency in Pennsylvania

801 - 820 of 926 forms

Form Title	Topics
RELATIVE PROVIDER AGREEMENT APPENDIX D – PARENT AND RELATED PROVIDER ATTESTATION OF RELATIONSHIP TO CHILD
REMICADE / INFLECTRA / RENFLEXIS (infliximab) [non-preferred] PRIOR AUTHORIZATION FORM
REPORTS
REQUEST FOR CRIMINAL RECORD CHECK SP 4-164
Request for Criminal Record Check Volunteers Only SP 4-164A
Request for Individual Access and Review SP 4-170
REQUEST FOR WAIVER OF CHILD CARE FACILITY REGULATION
Requirements for Provider Type 11 – Mental Health / Substance Abuse Services
Requirements for Provider Type 17 - Therapist
Requirements for Provider Type 19 - Psychologist
Requirements for Provider Type 21 – Case Manager
Requirements for Provider Type 23 - Nutritionist
Requirements for Provider Type 31 - Physician
Requirements For Provider Type 51-Home and Community Habilitation Provider Specialty Code
Requirements For Provider Type 52-Community Residential Rehabilitation Specialty Code
Requirements For Provider Type 54-Intermediate Service Organization
Requirements for Provider Type 55 - Vendor
Resident Assessment Support Plan RASP
RESIDENT DATA REPORTING MANUAL
RESOURCE & REFERRAL

1 contact point

Address:
234 Health and Welfare Building
Harrisburg, PA 17105-2675

Phone numbers:

Fax numbers:

Office of the Deputy Secretary for Administration