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How to fill out the Dhmh 4342 Form online
Filling out the Dhmh 4342 Form online can be a straightforward process if you follow the correct steps. This guide aims to provide clear instructions to ensure that you complete the form accurately and efficiently.
Follow the steps to properly fill out the Dhmh 4342 Form online
- Click the ‘Get Form’ button to access the Dhmh 4342 Form and open it in your browser.
- In section A, enter the date, your name as the case manager, your telephone number, and the address of the local department of social services. Also, include the recipient's name and the amount of excess resources.
- In section B, as the recipient or their representative, fill in the enclosed check amount and the recipient's name as listed in section A. Make sure to write the check payable to 'Medical Assistance Recoveries' and verify the mailing address: Medical Assistance Recoveries, P.O. Box 13045, Baltimore, Maryland 21203.
- Section C will be filled out by the Division of Medical Assistance Recoveries once they receive the check. Ensure that you retain a copy of the form for your records.
- Review all the information for accuracy. Once you are satisfied with the details provided, you can save the form, then download, print, or share it according to your needs.
Start completing your Dhmh 4342 Form online today to ensure a smooth submission process.
Maryland's Medicaid is commonly referred to as HealthChoice. It provides a wide range of health services for eligible individuals, including low-income families and those with disabilities. If you are looking to understand the enrollment process or need to complete the DHMH 4342 Form, USLegalForms can help you find the right resources and documentation.
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