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APD Provider Clearinghouse Information Update Notification

IMPORTANT: This form is NOT to update your AHCA Portal Account, please log in to the Clearinghouse to update your account information.

This form is for current APD Providers who have submitted a Notice of Intent and have an update to their information.

Please ensure your information is kept up to date!

Required Information* (this is as listed in the Clearinghouse, see example)

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