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Get MD DHMH 4345 1997

--------Is the individual considered to have a SERIOUS MENTAL ILLNESS? If the answer is Yes to all 3 of the above, check “Yes.” If the response is No to one or more of the above Yes No check “No.” If the individual is considered to have MI or MR or a related condition, complete Part D of this form. Otherwise, skip Part D and sign below. D. CATEGORICAL ADVANCE GROUP DETERMINATIONS 1. 2. 3. 4. 5. Is the individual being admitted for convalescent care not to exceed 120 days due to an.

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