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INTERQUAL LTAC ADMISSION CRITERIA

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Inpatient Notification Form - Tufts Health Plan
Aug. 2022 2 2113397 II. Inpatient NotificationForm Complete this section and submit using the instructions on page 1. Note: As a reminder, providers can submit an inpatient notification to Tufts Health Plan using the secure Provider website, as outlined on page 1. Requestor’s name: Requestor’s phone number: Ext. Requestor’s fax number:

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