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Be enrolled as a medicaid provider and have rates established or approved by the. Completion of the form by the enrollee´s health care provider is the responsibility of the. Web consumer /designated representative acknowledgement of the roles and responsibilities for receiving consumer directed personal assistance services Read instructions carefully before completing this form.
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Pdffiller allows users to edit, sign, fill & share all type of documents online. Consent to participate and consent to release personal and medical information. Web all fiscal intermediaries must have a contract/mou with the local social services district; (mou) consumer/designated rep acknowledgement of roles and.
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