Oha 3973 form-2025

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The Provider Enrollment Disclosure Statement outlines the requirements for individual performing providers to disclose ownership and control interests as part of compliance with federal and state regulations. It details the necessary information to be submitted, including personal identification details, any sanctions or criminal convictions related to healthcare programs, and relationships among individuals with ownership interests. The document emphasizes that failure to provide accurate disclosures may result in denial or termination of provider agreements with the Oregon Health Authority.

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2013	4.8 Satisfied (120 Votes)

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