bhcsproviders.acgov.org - /providers/QA/Forms/

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 1/28/2025 11:42 AM       283097 1st_Authorization_for_TBS_Services.pdf
  5/8/2025 11:44 PM        <dir> _vti_cnf
 9/14/2007 11:20 AM        77312 Advance Directive FORM.DOC
 9/14/2007 11:20 AM        80384 Advance Directive Policy 5-20-2004 revised.doc
 9/14/2007 11:20 AM        91136 ADVANCE DIRECTIVE Your Right To Make Decisions About Medical Treatment.doc
 1/28/2025 11:43 AM       344045 Authorization_for_Additional_TBS_Services.pdf
 1/28/2025 11:43 AM       289894 Authorization_for_Extended_TBS_Services.pdf
 9/14/2007 11:20 AM       167424 Beneficiary Death Report FORM.doc
 10/2/2007  2:52 PM        32768 Beneficiary Problem Resolution Information Form 05.doc
 9/14/2007 11:20 AM        67584 Beneficiary Problem Resolution Policy 05.doc
 9/14/2007 11:20 AM        80384 Beneficiary Right Policy 05.doc
 5/17/2011 10:18 AM       127488 Beneficiary_Death_Report_Template.dot
  4/8/2010  9:49 AM      2481473 Beneficiary_Rights.pdf
 9/14/2007 11:20 AM       155648 BHCS HIPAA Notice .doc
 6/22/2012  6:57 AM      1941821 Breach_Reporting_Policy.pdf
 9/14/2007 11:20 AM       151040 ClientReg.dot
10/23/2009  7:55 AM       196223 Cons&Fam_Grievance-Appeal_Form_9-09_CHINESEtrad.pdf
  6/4/2010 12:45 PM        64877 Cons&Fam_Grievance-Appeal_Form_9-09_ENGLISH.pdf
10/23/2009  7:55 AM       166258 Cons&Fam_Grievance-Appeal_Form_9-09_FARSI.pdf
10/19/2009  4:04 PM       169118 Cons&Fam_Grievance-Appeal_Form_9-09_SPANISH.pdf
10/23/2009  7:55 AM       198096 Cons&Fam_Grievance-Appeal_Form_9-09_VIET.pdf
 9/11/2008 12:58 PM        86016 consumer_grievance_Policy_08.doc
  6/3/2010  3:54 PM      1778784 Dr_Thomas_memo.pdf
 6/22/2012  6:57 AM       288189 Fed_Breach_form.pdf
  5/1/2025  7:12 AM       176367 Form_UR1-TBS_Request_for_Authorization_(3.25.25).pdf
  5/1/2025  7:12 AM       331067 Form_UR2a_TBS_1st_Authorization_for_TBS_Services_(3.25.25).pdf
  5/1/2025  7:12 AM       279850 Form_UR2b-TBS_Documentation_for_Additional_TBS_Services_(3.25.25).pdf
  5/1/2025  7:12 AM       105618 Form_UR3-Request_for_Extended_TBS _Authorization_(3.25.25).pdf
 9/14/2007 11:20 AM        31232 Freedom of Choice Notice Form 05.doc
  4/8/2010  9:49 AM      6602929 Grievance_and_Appeal_Process.pdf
 7/15/2022 12:12 PM      3420445 Grievance_Appeal_Poster_AR.pdf
 6/22/2012  6:57 AM       309022 HIPAA_Breach_Risk_Assessment.pdf
 9/14/2007 11:20 AM       209408 Notice of Privacy Practices HIPAA
 9/14/2007 11:20 AM        68608 Release of Information HIPAA 05.dot
 6/22/2012  6:57 AM       134144 Sentinel_Event_Client_Death_Report_Template.dot
11/15/2024 11:47 AM       138695 TBS-Request-To-Terminate.pdf
11/15/2024 10:47 AM       156120 TBS_1st_Authorization.pdf
 9/24/2024 11:23 AM     11564194 TBS_Coordination_of_Care_Manual__OCT2010_FINAL.pdf
 9/24/2024 11:24 AM       679776 TBS_Documentation_Manual_10_26_09.pdf
11/15/2024 10:47 AM       157461 TBS_Re-Review.pdf
 1/28/2025 11:43 AM       169249 TBS_Request_for_Authorization.pdf
11/15/2024 10:47 AM       113002 TBS_Request_for_extended_services_Authorization.pdf