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Document used for application, enrollment, registration or eligibility determination purposes.
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| Effective Date | Title - Owner - Description | |
07/01/2009 |
Determination of Incapacitated Status-Form 720 -
Division of Family Assistance -
Authorizes the FANF applicants physician or psychologist to disclose protected health information to the DHHS and obtains documentation from a physician or psychologist for an individual claiming to be physically or mentally incapacitated. |
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