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Get MO FA402 2014

Of 6 FA402 (05-14) MO HEALTHNET ELIGIBILITY REVIEW FORM DCN: Is anyone in the household blind or disabled? Yes No If Yes, who: __________________________ If you indicated that you are blind: 1. Do you have a sighted spouse? Yes No 2. Do you solicit alms? Yes No 3. Have you had eye surgery since the last review or application? Yes No 4. If you are under the age of 75, are you willing to have medical treatment or an operation to correct blindness? No 5. If recommended, are you willing to acce.

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