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FSPT Program Forms
Affidavit of Good Business Practice
Adobe Acrobat 64kb
MS Word version 40kb		   Memorandum of Agreement
Adobe Acrobat 116kb
MS Word version 64kb
Business Associate Agreement
Adobe Acrobat 76kb
MS Word version 100kb		   MOA Checklist
Adobe Acrobat 36kb
MS Word version 36kb
CFAR
Adobe Acrobat 164kb
MS Word version 240kb		 MOA Cover Letter
Adobe Acrobat 232kb
MS Word version 400kb
Billing Form Electronic
MS Excel 76kb		   Provider Demographic
Adobe Acrobat 108kb
MS Word version 108kb		  
Facility Registration Form
Adobe Acrobat 256kb
MS Word version 180kb		   Treatment Summary A-VI
Adobe Acrobat 68kb
MS Word version 32kb		  
FSPT Application Consent
Adobe Acrobat 256kb
MS Word version 164kb		   W-9 Form
Adobe Acrobat 256kb		  
FSPT Rate Sheet
Adobe Acrobat 44kb
MS Word version 40kb		  
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