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Get CO Load Letter Request Form

Loadletterrequests@hcpf.state.co.us If you are unable to send encrypted email, you may also fax your request to: 303-866-2082. No cover sheet is needed. DO NOT ALTER THIS FORM (*For Department Use Only: Please leave this section blank) * Eligibility Authorization Date: ____________ * Eligibility Transmit Date: ____________ *County of Residence: ________________________*Case number_________________ Revised 04/2017 .

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