AGENCY: Department of Health and Human Services. Community Health and Well-Being. Division of Population Health. Office of Health Promotion and Prevention

SERIES: 81960
TITLE: Maternal and infant health dental treatment claims files
DATES: 1984-
ARRANGEMENT: Numerical by claim number

DESCRIPTION: This is a copy of claims forms sent in by providers for treatment given children under the Maternal and Infant Health program. The claim form is sent elsewhere for payment and a copy is retained to answer payment questions. The files include the name and address of the patient; the percentage of the bill to be paid by the patient and by the state; the dentist's name, address, social security number or federal identification number and telephone number; and a record of the treatment given the patient and the total amount of the fee.

RETENTION

Retain for 1 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series were specifically approved by the State Records Committee.

APPROVED: 06/1987

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

Administrative

This record has administrative value only.

PRIMARY DESIGNATION

Private

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