Affidavit of No Social Security Number - EMS Professional License
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Health Services, DPH, DPH
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Affirmation of Identity, Residency, and/or Income
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Health Services, DPH, DPH
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Agency Application for Access to Web-Based Personal Care Screening Tool
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Health Services, DMS, DMS
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Agency Data Security Staff User Agreement
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Health Services, DMS, DMS
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Agency Position on the Medicaid Eligibility Quality Control (MEQC) Error Finding
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Health Services, DMS, DMS
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Agency Position on the State Quality Control (QC) Finding
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Health Services, DMS, DMS
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Agency Response to the State Quality Assurance (QA) Medicaid Finding
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 12 - 14 Years
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 12 to 18 Months
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 14 - 18 Years
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 18 to 24Months
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 18 Years and Up
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 24 to 36 Months
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 36 Months - 4 Years
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 4 - 6 Years
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 6 - 9 Years
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 9 - 12 Years
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: Birth - 6 Months
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Health Services, DMS, DMS
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Age-Specific ADL / IADL Answer Choices for Cildren's Long-Term Support Programs Age: 6 - 12 Months
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Health Services, DMS, DMS
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Aging/ADRC Integration Funding Budget Worksheet
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Health Services, DPH, DPH
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