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Get DADS Or HHSC Form - The Texas Department Of Aging And ... - Dads State Tx

Begin Date Street Address City State Legally Authorized Representative (LAR) Primary Contact Number Relationship Area Code and Telephone No. LAR/Primary Contact Address (Street, City, State, ZIP Code) Fax Area Code and No. ZIP Code Alternate Area Code and Telephone No. Email Address Alternate Email Address Alternate Contact Name Relationship Alternate Contact Address (Street, City, State, ZIP Code) Area Code and Telephone Number Alternate Telephone Number Provider Agency Name.

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