Bill Only Form

Note: No patient information/PHI should be transmitted utilizing this form.
I have read, acknowledge and agree to the SHS vendor management policy letter. I have also checked all product identified for any outdates/expirations.
One file only.
50 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
One file only.
25 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
CAPTCHA
5 + 3 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.