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Pennsylvania Long Term Care Medicaid Eligibility Guidelines  Form

Pennsylvania Long Term Care Medicaid Eligibility Guidelines Form

Use a pa600l template to make your document workflow more streamlined.

Applying for Care in a Facility Home and Community Waiver Services Other Type/Name of Waiver/Service Please read the entire application form Print the requested information in the unshaded sections If you need help another person can help you or you can get help from your county assistance office the information in our records. If you need help to obtain any information ask the You or any representative you choose may complete this application* Your representative can be your spouse a friend a...
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