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Get Hfs 2538b Form 2011-2024

Program services. See WAG 20-28-01. (Note: Enter Social Security Number for new applicant only). CASE LOAD NUMBER (if available): This is to notify the FCRC that the person named above receives services from the Department on Aging (DoA) Community Care Program (CCP). 1. STATUS OF MEDICAID ELIGIBILITY (CHECK ONE) The person named above has completed an application for medical benefits. Form 2378H is attached. The person named above has an active medical case. 2. STATUS OF COMMUNITY CARE PRO.

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