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PRINTABLE APPLICATIONS (PDF)

Information entered into PDF applications cannot be saved. You must print, sign, and return (by email, fax, or mail) the completed application to LSA.

QUESTIONNAIRES

If you perform any of these procedures, please submit the appropriate questionnaires with your application.

FORMS

HIPAA-HITECH Business Associate Agreement
An agreement required by federal law concerning policies and procedures to assure the confidentiality of patient health information.

 

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