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Local Health Departments and Private Vendors Forms

Forms commonly used by the twenty-four Local Health Departments
Schedule of Charges - DHMH 4411 A & B
LHDSochargeA.pdf
FY 15 Non-Chargeable List
FY 15 Out Patient Services - Ability to Pay Scale
ADAA Halfway House, Long Term Care & Residential ICF - Ability to Pay Scale
FY 15 ADAA ATPS Instructions
FY 15 Adult Day Care Services - Ability to Pay Scale
Worksheet to be used for Halfway House, Long Term Care & Residential ICF
Forms Commonly used by the Private Vendors
ADAA4411aschedule.doc Schedule of Charges - DHMH 4411 A & B
ADAA4411aschedule.pdf 
ADAA4411bschedule.xls
ADAA4411bschedule.pdf 
ADAAdefinition4411b.doc
ADAAdefinition4411b.pdf
FY 15 Non-Chargeable List
FY 15 Out Patient Services - Ability to Pay Scale
ADAA Halfway House, Long Term Care & Residential ICF - Ability to Pay Scale
ADC-AbilitytoPayScheduleFY15 FY 15 Adult Day Care Services - Ability to Pay Scale
ADC-AbilitytoPayScheduleFY15
Worksheet to be used for Halfway House, Long Term Care & Residential ICF
ADAAResWorksheet.pdf
FY 15 ADAA ATPS Instructions
ADAA-ATPS-InstructionsFY15