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Med Quest 2013-2023
Number and date of signature and Name of applicant/recipient s health plan and licensed treating physician s Medicaid provider number or NPI. DISABILITY as defined by law is the inability to engage in any substantial gainful activity SGA by reason of any medically determinable physical or mental impairment s which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve 12 months. GENERAL INSTRUCTIONS The health plans or...
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