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Get Form 02CB005E. Service Team Release Of Information

OK Medicaid number Zip MEMBER CHOICE AND CONSENT I have been informed of available services to meet my assessed need for assistance and of the qualified providers of each of these services in my area, from which I have freely Member initials selected my services and providers of those services. D I have chosen as my new case management provider. D I have chosen as my new home care provider. I authorize the Oklahoma Department of Hum.

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