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Get DD 2792 2014

note: Each addenda is completed, and submitted for EFMP review, only if applicable to the patient described. SIGNATURE of a Qualified Medical Provider is REQUIRED. DD FORM 2792 INSTRUCTIONS, AUG 2014 Items 10.a. - c. To be completed by the administrator in consultation with the family. Mark (X) all services being provided to the family member. Items 11.a. - c. Parent/Guardian or Person of Majority Age. Parent/ guardian or person of majority age certifies that the information contained in the .

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