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Get KY MAP-116 2015-2024

Participant Authorization Participant I give approval to share the service plan I, my Authorized Representative, and/or Legal Guardian have signed the Service Plan signature sheet I certify that I and/or my Legal Representative have been informed of waiver services I understand that under the waiver programs, I may request services from any Medicaid provider qualified to provide the service and that a listing of currently enrolled Medicaid providers may be obtained from Me.

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Keywords relevant to KY MAP-116

  • medicaid
  • waiver
  • enrolled
  • provider
  • listing
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