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Form 0917-0009-4 0917-0009-4, Medical Privileges Request Form
Indian Health Service Medical Staff Credentials Application
Medical_privileges_request_form[1]
Medical Privileges Request Form
OMB: 0917-0009
OMB.report
HHS/IHS
OMB 0917-0009
ICR 202002-0917-002
IC 46245
Form 0917-0009-4 0917-0009-4, Medical Privileges Request Form
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0917-0009 can be found here:
2023-08-01 - Revision of a currently approved collection
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File Type
application/msword
File Title
Circular Appendix 95-16-C.1
Subject
Medical Privileges
Author
Kennington Wall
Last Modified By
Kennington Wall
File Modified
2013-01-16
File Created
2012-12-11
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