PDF
Word
Form GW-OMR-PM-1 Provider Medical Statement - Rhode Island
What Is Form GW-OMR-PM-1?
This is a legal form that was released by the Rhode Island Executive Office of Health and Human Services - a government authority operating within Rhode Island. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form GW-OMR-PM-1?A: Form GW-OMR-PM-1 is the Provider Medical Statement for the state of Rhode Island.
Q: What is the purpose of Form GW-OMR-PM-1?A: Form GW-OMR-PM-1 is used to document medical information for individuals receiving welfare or public assistance in Rhode Island.
Q: Who is required to fill out Form GW-OMR-PM-1?A: Providers who are treating or examining individuals requesting welfare or public assistance in Rhode Island are required to fill out this form.
Q: Is Form GW-OMR-PM-1 specific to Rhode Island?A: Yes, Form GW-OMR-PM-1 is specific to the state of Rhode Island and may not be used in other states.
Form Details:
- Released on March 1, 2014;
- The latest edition provided by the Rhode Island Executive Office of Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form GW-OMR-PM-1 by clicking the link below or browse more documents and templates provided by the Rhode Island Executive Office of Health and Human Services.
Download Form GW-OMR-PM-1 Provider Medical Statement - Rhode Island
1
2
3
