bbs form
new york state medicaid program inpatient hospital billing
Dec 1, 2009 This document is customized for Inpatient Hospital providers and should be used by the provider as an instructional as well as a reference tool.
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Weekly Log of Experience Hours
Use a separate log for each supervisor and for each work setting. Do not submit to the Board unless specifically requested. Name of Trainee/Associate: Last.
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WEEKLY SUMMARY OF HOURS OF EXPERIENCE
THIS FORM SHALL BE COMPLETED PURSUANT TO TITLE 16, CALIFORNIA CODE OF REGULATIONS SECTION 1833(e). (Use a separate log for each supervised work setting and for
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