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Form 470-5551 Community-Based Neurobehavioral Rehabilitation Services (Cnrs) Provider Quality Management Self-assessment - Iowa, 2020 PDF

Form 470-5551 Community-Based Neurobehavioral Rehabilitation Services (Cnrs) Provider Quality Management Self-assessment - Iowa, 2020
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Form 470-4698 Iowa Medicaid Critical Incident Report - Iowa PDF

Form 470-4698 Iowa Medicaid Critical Incident Report - Iowa
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Formulario 470-0462(S) Solicitud De Ayuda Financiera Y Asistencia Alimenticia - Iowa (Spanish) PDF

Formulario 470-0462(S) Solicitud De Ayuda Financiera Y Asistencia Alimenticia - Iowa (Spanish)
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Form 470-0462 Food and Financial Support Application - Iowa PDF

Form 470-0462 Food and Financial Support Application - Iowa
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Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa PDF

Form 470-5170 Application for Health Coverage and Help Paying Costs - Iowa
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Form 470-5170(S) Solicitud De Cobertura Medica Y Asistencia Para Abonar El Costo - Iowa PDF

Form 470-5170(S) Solicitud De Cobertura Medica Y Asistencia Para Abonar El Costo - Iowa
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Form 470-3624 Child Care Assistance Application - Iowa PDF

Form 470-3624 Child Care Assistance Application - Iowa
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Formulario 470-3624(S) Solicitud De Subsidio Para El Cuidado De Ninos - Iowa (Spanish) PDF

Formulario 470-3624(S) Solicitud De Subsidio Para El Cuidado De Ninos - Iowa (Spanish)
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Form 470-3985 Request for List of Disclosures - Iowa PDF

Form 470-3985 Request for List of Disclosures - Iowa
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Form 470-3947 Request to Change How Health Information Is Provided - Iowa PDF

Form 470-3947 Request to Change How Health Information Is Provided - Iowa
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Certificate of Immunization Exemption - Religious - Iowa PDF

Certificate of Immunization Exemption - Religious - Iowa
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Form 470-3767 Access to Confidential Abuse Information and Non-redissemination Agreement - Iowa PDF

Form 470-3767 Access to Confidential Abuse Information and Non-redissemination Agreement - Iowa
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Form 470-0447 Report on Incapacity - Iowa PDF

Form 470-0447 Report on Incapacity - Iowa
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Form 470-3826 Request for Fip Beyond 60 Months - Iowa PDF

Form 470-3826 Request for Fip Beyond 60 Months - Iowa
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Form 470-5273 Iowa Medicaid Health Home and Integrated Health Home Provider Application - Iowa PDF

Form 470-5273 Iowa Medicaid Health Home and Integrated Health Home Provider Application - Iowa
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Form 470-5298 Iowa Medicaid Enterprise (Ime) Provider Enrollment Application Fee Hardship Exemption Request - Iowa PDF

Form 470-5298 Iowa Medicaid Enterprise (Ime) Provider Enrollment Application Fee Hardship Exemption Request - Iowa
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Form 470-5324 Core Standardized Assessment (Csa) Document Access Request for the Iowa Medicaid Portal Access (Impa) System - Iowa PDF

Form 470-5324 Core Standardized Assessment (Csa) Document Access Request for the Iowa Medicaid Portal Access (Impa) System - Iowa
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Form 470-5362 Iowa Medicaid Memorandum of Understanding (Mou) for Value Based Purchasing Support Activities - Iowa PDF

Form 470-5362 Iowa Medicaid Memorandum of Understanding (Mou) for Value Based Purchasing Support Activities - Iowa
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Form 470-0665 Report of Suspected Child Abuse - Iowa PDF

Form 470-0665 Report of Suspected Child Abuse - Iowa
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Form 470-0672 Provider Health Assessment - Iowa PDF

Form 470-0672 Provider Health Assessment - Iowa
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Form 470-0648 Statement of Services Rendered - Iowa PDF

Form 470-0648 Statement of Services Rendered - Iowa
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Instructions for Form 470-4829 Nursing Facility Enhanced Medicaid Payment Report - Iowa PDF

Instructions for Form 470-4829 Nursing Facility Enhanced Medicaid Payment Report - Iowa
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Form 470-5110 Home-And Community-Based Services (Hcbs) Intellectual Disability Waiver Priority Need Assessment - Statewide Waiting List - Iowa PDF

Form 470-5110 Home-And Community-Based Services (Hcbs) Intellectual Disability Waiver Priority Need Assessment - Statewide Waiting List - Iowa
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Form 470-5111 Ordering/Referring Provider Enrollment Application - Iowa PDF

Form 470-5111 Ordering/Referring Provider Enrollment Application - Iowa
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Form 470-5112 Designated Contact Person - Iowa PDF

Form 470-5112 Designated Contact Person - Iowa
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Family Child Care Environment Rating Scale - Fccers-R - Iowa PDF

Family Child Care Environment Rating Scale - Fccers-R - Iowa
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Self-assessment Infant/Toddler Environment Rating Scale - Iters-R - Iowa PDF

Self-assessment Infant/Toddler Environment Rating Scale - Iters-R - Iowa
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Family Child Care Environment Rating Scale - Fccers-R - Iowa PDF

Family Child Care Environment Rating Scale - Fccers-R - Iowa
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School-Age Care Environment Rating Scale - Sacers - Iowa PDF

School-Age Care Environment Rating Scale - Sacers - Iowa
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Early Childhood Environment Rating Scale - Ecers-R - Iowa PDF

Early Childhood Environment Rating Scale - Ecers-R - Iowa
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Infant/Toddler Environment Rating Scale - Iters-R - Iowa PDF

Infant/Toddler Environment Rating Scale - Iters-R - Iowa
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Iowa Child Care Nurse Consultant Injury Prevention Checklist - Iowa PDF

Iowa Child Care Nurse Consultant Injury Prevention Checklist - Iowa
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Health and Safety Assessment - Iowa PDF

Health and Safety Assessment - Iowa
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Form 470-4236 Professional Development Plan - Iowa PDF

Form 470-4236 Professional Development Plan - Iowa
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Form HCCI-CRR2006 Child Record Review - Iowa PDF

Form HCCI-CRR2006 Child Record Review - Iowa
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Form 470-3301 Authorization for Release of Child and Dependent Adult Abuse Information - Iowa PDF

Form 470-3301 Authorization for Release of Child and Dependent Adult Abuse Information - Iowa
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School-Age Care Environment Rating Scale - Sacers - Iowa PDF

School-Age Care Environment Rating Scale - Sacers - Iowa
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Form 470-2310 Record Check Evaluation - Iowa PDF

Form 470-2310 Record Check Evaluation - Iowa
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Form 470-0643 Request for Child and Dependent Adult Abuse Information - Iowa PDF

Form 470-0643 Request for Child and Dependent Adult Abuse Information - Iowa
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Form 470-5619 Medicaid Supplemental Information Prior Authorization Form - Iowa PDF

Form 470-5619 Medicaid Supplemental Information Prior Authorization Form - Iowa
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