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Get TX DME Certification And Receipt Form 2011-2024

St be completed before the DME provider can be paid for durable medical equipment provided to a Medicaid client. Esta certificaci n es necesaria bajo la Secci n 32.024 del C digo de Recursos Humanos y se debe Ilenar antes de poder rembolsar al proveedor del equipo m dico duradero por cualquier equipo m dico proporcionado al cliente de Medicaid. Section A: Client Information Name: Address: Telephone Number: Medicaid ID Number: City State Alternate Telephone Number: Section B: Provider Inf.

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