MAA Submission
Select all the hospitals you are activating/deactivating for MAA
Select or enter value
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Caret symbol
Activate/Deactivate
Activate
Deactivate
Activate/Deactivate Date
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Calendar
Name of person authorizing MAA activation/deactivation
Job title of person authorizing
Your name
Your job title
Your email address
*
A copy of your submission will be emailed to you.
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