050-17 : Provider Closure Notification Form (DP 1061)

The Provider Closure Notification Form (DP 1061) is used to ensure that all ODP waiver and system requirements are met for any provider who no longer intends to provide ODP Consolidated and/or Person/Family Directed (P/FDS) Waiver services.

Attachment 050-17 : Provider Closure Notification Form (DP 1061)

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