' Indian Health Manual (IHM) - Part 2, Chapter 3:  Manual Exhibit 2-3-H
Skip to site content

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

Scroll To Top

     Indian Health Manual

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            
 

 

                 
 

 

                 
 

 

                 
 

 

                 
 

 

                 
 

 

                 
 

 

                 
 

 

                 
 

 

                 
 

 

                 
 

 

                 


Back To Top  |  Previous Page
CPU: 24ms Clock: 0s