AGENCY: Department of Health and Human Services. Office of Children with Special Healthcare Needs

SERIES: 7812
TITLE: Authorization for compensable services
DATES: 1985-
ARRANGEMENT: None

DESCRIPTION: This is an authorization given to health care providers by the department to give clients specific treatment. Without this authorization, the department may refuse to pay for these services. This copy of the record is used as a suspense file. It includes the health care provider's name, address, and vendor number, the date of the authorization, the low organizational, account, and activity code numbers to be charged, the specific service(s) authorized, the signature of the authorizing official, and the signature of the department head or the authorized agent.

RETENTION

Retain for 1 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 08/1986

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year or until the health care provider returns the record copy and then destroy.

APPRAISAL

Administrative

Seven copies of this form are made and distributed. The sole purpose of the copy is to make sure that the copy sent to the health care provider is returned to the state. If it is not returned, follow-up action is taken on the matter. Once the provider returns the form, this copy is no longer needed.

PRIMARY DESIGNATION

Private

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