Fax Cover Sheet Template Pdf
Missouri Department of Health and Senior Services
Southwestern District – Landers State Office Bldg
149 Park Central Sq. Suite 116, Springfield MO 6580 Phone: 417-895-6900 Fax: 417-895-6975
RELAY MISSOURI for Hearing and Speech Impaired 1-800-735-2966 VOICE 1-800-735-2466
Jeremiah W. (Jay) Nixon
This facsimile transmission is from the Missouri Department of Health and Senior Services. It contains
confidential or privileged information that may be protected from disclosure by law. Unauthorized disclosure,
review, copying, distribution, or use of this message or its contents by anyone other than the intended recipient is
prohibited. If you are not the intended recipient, please immediately destroy this message and notify the sender
immediately by calling the phone number listed above to arrange for return of the original document to the
Missouri Department of Health and Senior Services. Thank you.
Healthy Missourians for life.
The Missouri Department of Health and Senior Services will be the leader in promoting, protecting and partnering for Health.
AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER: Services provided on a nondiscriminatory basis.