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Albuquerque New Mexico online Form 5500 - Schedule H: What You Should Know
Fill out all fields in the application. (2.) Print the completed form, and complete the required sections. (3.) When complete and printed, attach a photocopy of your doctor's medical license, (if a NM Resident, you must include all doctors). Note: Do not complete section 10, as it is required for each of the three doctors you must submit your application to. Filer's Signature. (Please refer to the application instructions for additional information. ) Filing Fee 25.00 Filing Fee 25.00 fee is due at the time of filing the application. (1.) For a controlled substance, the application fee is collected after we receive the application, fill out the information, and sign the application. (2.) The fee is the total cost of the application, including the necessary services and materials of the applicant. We will not refund the fee in order to register a provider, nor will we refund the cost of registration if the drug or dangerous drug is not registered and the patient leaves the treatment facility to attend another clinic. Note — The fee includes our administrative overhead and payment of any excess registration. The fee is nonrefundable For registration information, see: Schedule N prescribes controlled substances on a Schedule I Controlled Substance Schedule (see Schedule I) and prescribes other controlled substances listed in Schedule N and Schedule O (see) to patients under age 18. Schedule N is not a registry of patients who need medical care, or treatment services, that are not covered by Medicare and have a Medicare-eligible patient count. For more information on prescribing schedule X and schedule O, click here Schedule O is not a registry of medical services or prescriptions that do not qualify for Medicare or the State Health Benefits Plan. For further information on Schedule O, click here To register your program under Schedule N, you must agree to: All patients will have their medical treatment covered by the Medicaid program, through CHIP, Medicare, or the State Health Benefits plan, unless you do not use these plans. Patients have no obligation to participate in any Medicare benefit unless they are eligible under Medicare and have an eligible patient count.
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