File: Excel Sheet Download 30932 | Invoice And Service Log And Staff List
sheet 1 invoice facility name contractor name facility address remit address program ru invoice contact personname contract number invoice month and year contact phone service code total units of service ...
Filetype Excel XLSX | Posted on 08 Aug 2022 | 3 years ago
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...Sheet invoice facility name contractor address remit program ru contact personname contract number month and year phone service code total units of unit rate claimed amount totals attestation claim i hereby certify that am the official who is responsible for claiming reimbursement specified in attached documents to best my knowledge belief these claims are all respect true correct completed accordance with applicable law services were provided clients written treatment plan have been documented client record if understand payment may be from federal andor state county funds any falsification or concealment a material fact prosecuted under laws approved by executive director designee signature date print title individual log monthyear programru primary staff duration id location practitioner billable minutes grand group costaff co clts div...