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Get Cw215a Form

Ks Intercounty Transfer will not be picked up in the receiving county. A Medi-Cal referral must be completed for this case. Please provide copies of the documents indicated below to the worker in the receiving county within ten calendar days. RECEIVING COUNTY INFORMATION RECEIVING COUNTY DATE REQUESTED WORKER NAME WORKER NUMBER COUNTY ADDRESS (NUMBER, STREET) CITY COUNTY PHONE NUMBER FAX NUMBER ( ( ZIP CODE ) E-MAIL ADDRESS ) CASE NAME/BENEFICIARY INFORMATION CASE NAME SENDING COU.

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