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Get and Sign Med Quest 1149 2013-2022 Form

Get and Sign Med Quest 1149 2013-2022 Form

Use a Med Quest 1149 2013 template to make your document workflow more streamlined.

INSTRUCTIONS: I. II. The form will be completed by a licensed physician A. The physician will certify that an emergent medical condition exists based on the diagnosis, the consequences of not receiving immediate treatment, and the treatments, medications, and/or medical supplies that are needed immediately and can not be obtained without medical insurance. B. The physician will complete and sign the form. C. The form shall be forwarded to the DHS Eligibility Branch where the...
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