Attachment to Form 342 for Wheelchair Evaluation Request

Medicaid Agency

This government document is issued by Medicaid Agency for use in Alabama

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File Details: PDF (982 KB)
Downloads: 68
Source
https://medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/9.4.14_PA_Forms/9.4.14_PA_Form_384_Wheelchair_Eval_Revised_7-17-17.pdf

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