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Get MD Health Form PAC 2010

F you are 65 or over, and do not have Medicare, you must send proof that you applied for Medicare from the Social Security Administration. Section 3: O. Check race. You may check more than one race for each person applying for PAC. P. Check whether ethnicity is Hispanic or Latino. Q. Primary language information is optional. Indicate if a translation service is needed for us to speak to you. R. Check sections for visually or hearing impaired if they apply to you. Revised 01/2010. Previous.

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