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Form # CMS 1539
Form Title MEDICARE/MEDICAID CERTIFICATION AND TRANSMITTAL
Revision Date 07/01/1984
O.M.B. # EXEMPT
O.M.B. Expiration Date N/A
CMS Manual N/A
Special Instructions N/A

 


 
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CMS 1539 (426 KB)

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Last Modified Date : 10/21/2008
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