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knowledge been ordered by that professional in bona fide compliance with the procedures set forth in the manual and revisions. all care, services and supplies for which claim is made are medically necessary for the treatment of the named recipient, the amounts listed are due and, except as noted, no part
has been compliance with the federal civil rights act of and with section of the federal rehabilitation act of , as amended, which forbid discrimination on the basis of race, color, national origin, handicap, age, sex and religion; i agree (or the entity agrees) to comply with the requirement of cfr part...
https://www.emedny.org/info/ProviderEnrollment/ProviderMaintForms/490501_ETIN_CERT_Certification_Statement_Cert_Instructions_for_Existing_ETINs.pdf