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Get IA DHS 470-0254 2014

Ies (from the listing below) that are part of this business and subject to the Iowa Medicaid Provider Agreement. • Attach current certification document(s) as indicated on the list below. • Only the individuals or institutional categories listed by the business on this form are eligible for Medicaid reimbursement. • Categories in bold below are considered Moderate or High risk and subject to a pre/post enrollment site visit and other enhanced screening requirements. Type Code 1 2 3 4 5 6 7.

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