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NEW YORK STATE DEPARTMENT OF HEALTH Office of Managed Care Bureau of Managed Care Certification and Surveillance Utilization Review Agent Registration Application and Attestation Complete and sign this form. Submit with completed Utilization Review Registration Application Summary/Checklist DOH-4291B unless reregistrant attests below that there are no changes to previous application. Check one New application Re-registration Name of Applicant Street Address City State Zip Name of Chief...

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