B h s fill in the blanks form 2025

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  1. Click ‘Get Form’ to open the b h s fill in the blanks form in the editor.
  2. Begin by entering the 'Name of Facility/Agency' in the designated field. Ensure that you provide the full legal name for accurate identification.
  3. Next, fill in the 'Street' address. This should include any suite or unit numbers if applicable.
  4. Proceed to enter your 'City/State/Zip Code'. Make sure to format this correctly for proper mailing.
  5. In the 'Telephone Number' field, include your area code and ensure that it is a valid contact number.
  6. Indicate your 'Facility/Agency Fiscal Year End' date. This is crucial for financial reporting purposes.
  7. Fill out the 'Intermediary Name', which is essential for processing your information accurately.
  8. Lastly, provide details for 'Facility/Agent Representative'. This person will be your point of contact.
  9. Review all entries for accuracy before saving or submitting your completed form.

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