Fillable form to designate a beneficiary of patient trust funds - Return to Alabama Medicaid Agency/Estate Recovery Unit

Medicaid Agency

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

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File Details: PDF (178 KB)
Downloads: 17
Source
https://medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/9.4.1_Applicant-Recipient_Forms/9.4.1_LTC_Estate_Admin_Desig_Form_12-22-14.pdf

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