AGENCY: Davis County (Utah). Health Department. Nursing Division
SERIES: 10945
TITLE: Child Health Evaluation Care medicaid reimbursement report
DATES: 1990-2012.
ARRANGEMENT: None
DESCRIPTION: This form reports the reimbursements received on claims for physical examinations provided under the Child Health Evaluation (CHEC) program. A medicaid billing form is submitted for each completed examination and the original is submitted to the Utah Medical Assistance Program (UMAP) for reimbursement. This form includes child's name, date service provided, date into program, home address, phone number, medical information and patient identification number.
RETENTION
Retain for 3 year(s)
DISPOSITION
Destroy.
RETENTION AND DISPOSITION AUTHORIZATION
Retention and disposition for this series is proposed and has not yet been approved.
FORMAT MANAGEMENT
Paper: Retain in Office for 3 years and then destroy.
APPRAISAL
PRIMARY DESIGNATION
Private