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we will now continue on with this audiovisual piece and the supplement a application this second application is important because it provides us with all the resource information required for a chronic care case in order to determine full financial eligibility sections a through f must be completed by or for chronic care applicants and it must be signed and dated at the end on page six here put down the full legal name of the person who needs our financial medical assistance last name first name middle initial their social security number and their marital status the following questions can be answered by checking the yes or no box whichever one applies page one be blind disabled or chronically ill is the person named in Section A above chronically ill some examples of chronically ill would be someone who has been unable to work for at least 12 months because of illness or injury or having an illness or disabling impairment that has lasted or is expected to last for more than 12 months


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