dhb-7098-I DMA-7098 - Additional Information and Instructions

Form Numberdhb-7098-I
Medicaid Form Numberdhb-7098-I
Agency/DivisionHealth Benefits/NC Medicaid (DHB)
Form Effective Date 2021-02-23T00:00:00-05:00
Form File DHB-7098 Local Agency REQUEST AND AUTHORIZATION TO DISCLOSE HEALTH INFORMATION, 01_27_2021.pdf