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  • Mi Msa-4674a 2014

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Structions, Copy Distribution, PA 431 and Non-Discrimination Information. SECTION I - DHS Specialist Completes: DHS Specialist Name Phone No. ( DHS Case Number MA-TOA Authorized Rate Standard Special ) CO # DIST # Patient/ Beneficiary Name Beneficiary ID No. Address (No. & Street, City, State, ZIP Code) SECTION II - Medical Provider Completes: Medical Provider's Name NPI Number Chronic, ongoing illness? (This usually means monthly ongoing care, but may include less than monthly car.

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MSA-4674-A Related content

MSA-4674, Medical Transport Statement - State of...
SECTION I - MDHHS Specialist Completes. Only ONE medical provider and ONE transporter per...
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You can contact the county office where you resided when your case closed by calling 1-844-4MI-DHHS (1-844-464-3447).

How do I cancel my Medicaid in Michigan? You can call Michigan ENROLLS at 888.367. 6557 (TTY 771) to cancel your Michigan Medicaid.

Your caseworker's e-mail address is always their specialist ID followed by @michigan.gov. You can find your caseworker's specialist ID on the top right corner of a notice you received from the Michigan Department of Health and Human Services (MDHHS). The specialist ID is usually a combination of the specialist's name.

Who can I call if I have questions or experience technical issues in the new MI Bridges? A. A dedicated Help Desk is available via phone to community partners and clients 8am – 5pm Monday – Friday. You can call 1-844-799-9876 to contact the Help Desk.

The Michigan Department of Health and Human Services (MDHHS) is a principal department of state of Michigan, headquartered in Lansing, that provides public assistance, child and family welfare services, and oversees health policy and management, including mental health and substance abuse services.

General Contact Information 517-335-8448 (phone) 517-335-8835 (fax) 1-800-942-1636 (toll-free) 517-335-8951 (voc)

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232