Form 3613, Provider Investigation Report with Fax Cover Sheet (Home Health, Hospice and Personal Assistance Services Provider Use Only)

Texas Health and Human Services

This government document is issued by Texas Health and Human Services for use in Texas

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File Details: PDF (204 KB)
Downloads: 6
Source
https://www.hhs.texas.gov/regulations/forms/3000-3999/form-3613-provider-investigation-report-fax-cover-sheet-home-health-hospice-personal-assistance

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