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NY OPWDD Level Of Care Eligibility Determination (LCED) Form 2020
Get NY OPWDD Level Of Care Eligibility Determination (LCED) Form 2020-2024
ED) FORM For Home and Community Based Services (HCBS) Waiver, Comprehensive Care Coordination and other State Plan Services. Please refer to the accompanying Instructions for information on completing this form. Clear Form Name of Individual D.O.B. Address Responsible Medicaid District Individual s Medicaid (CIN) Dates of Pre-Enrollment Evaluations: Physical Status: 620/621 TABS ID #: Social Psychological This Information must be kept Confidential by Recipient ELIGIBILITY DETERMINATION.
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