CMS013088 | Centers for Medicare & Medicaid Services

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Form #: CMS 1771
Form Title: ATTENDING PHYSICIANS STATEMENT AND DOCUMENTATION FOR MEDICARE EMERGENCY
Revision Date: 09/01/1977
O.M.B. #: 0938-0023
O.M.B. Expiration Date: 07/31/2014
CMS Manual: N/A
Special Instructions: N/A

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CMS 1771 (12 KB) [PDF, 106KB]

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