U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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      Indian Health Manual

Delegations of Authority:
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Part 2, Chapter 3:  Manual Exhibit 2-3-H

Commitment Register

Date of Authorization

Authorization Number
Name of Patient
Name of Provider
Date of Service
All Other Obligation Balance
Dental Obligation Balance
Date Submitted to Finance for Payment
  IHS-43

IHS-64

 IHS-57            
 

 

                  
 

 

                  
 

 

                  
 

 

                  
 

 

                  
 

 

                  
 

 

                  
 

 

                  
 

 

                  
 

 

                  
 

 

                  

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