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Get And Sign Michigan Action Notice Form

Advance Action Notice no longer functionally eligible for services based on the Michigan Medicaid Nursing Facility Level of Care Determination and attempts at discharge planning have failed. The Nursing Facility Transition Team is available to assist. 2 Ineligible - Termination of Services. 3 rev. 11/2012 MI Choice Provider Letterhead Adverse Action Notice Date Name Address City State Zip code Dear Following a review of your long term care needs ......

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