5010 Appendix A

Here is the Appendix A form, which you need to complete according to the instructions and mail back to them.

http://www.ncdhhs.gov/dma/hipaa/5010Appendix2.pdf

Here is an article with more information about the Appendix A and what to check on it:

http://kb.barnestorm.us/KnowledgebaseArticle50693.aspx?Keywords=TPA