HB 4004 Incentive Distribution Report - Due August 1, 2022
Provider Legal Business Name
*
Please specify the amount allotted to the following categories: Executive Leadership
*
Amount Allotted Physician/Psychiatrist
*
Amount Allotted Program Manager
*
Amount Allotted Supervisor
*
Amount Allotted Clinical/Medical Staff
*
Amount Allotted Non-clinical staff
*
Number of vacant positions filled
*
If you did not submit a recruitment strategy with your original application, or if you have any additional supporting documentation, please attach below.
File Upload
Drag and drop files here or
browse files
Send me a copy of my responses
Submit
Powered by
Smartsheet Modern Logo On Light
Privacy Notice
|
Report Abuse