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Dhmh 125b1  Form

Dhmh 125b1 Form

Use a Dhmh 125b1 template to make your document workflow more streamlined.

10.07.14.22I This is to request a resident-specific level of care waiver in accordance with COMAR 10.07.14.22 to permit (resident’s name) to continue to reside in the facility. I certify that the program is capable of and wishes to care for this resident and that in doing so the needs of other residents will not be jeopardized. I am requesting this waiver, with the consent of the resident’s representative, because: (check if applicable) The level of care required by the resident exceeds the...
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