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Get and Sign INSTRUCTIONS DHS 1139B Rev Med Quest 2010-2022 Form

Get and Sign INSTRUCTIONS DHS 1139B Rev Med Quest 2010-2022 Form

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INSTRUCTIONS DHS 1139B Rev. 08/10 NON-EMERGENCY GROUND TRANSPORTATION TAXI CABS ATTACHMENT PURPOSE Form DHS 1139B shall be used by health care providers who provide non-emergency ground transportation. This form shall be submitted with a completed DHS 1139 Medicaid Application/Change Request Form. 1. ...
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