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Indian Health Service The Federal Health Program for American Indians and Alaska Natives


     Indian Health Manual
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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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