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Get Medicaid Disability Application (spanish), F-10112s

CIONES: Usted tiene que devolver las ocho p ginas de este formulario de solicitud. Este formulario lo deben completar las personas que requieren de una determinaci n de discapacidad en el proceso de solicitud de Medicaid. Este formulario lo debe completar el solicitante o su representante. Si est completando esta solicitud en nombre de otra persona, llene el formulario F-10126S Medicaid / FoodShare Wisconsin Authorization of Representative, o incluya la documentaci n legal que le autoriza c.

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