| 2021-04-05_Utah_Medicaid_Initial_Wheelchair_Evaluation_Form.docx |
2021-04-05_UTAH_MEDICAID_INITIAL_WHEELCHAIR_EVALUATION_FORM.DOCX File |
188,190 |
Apr 22 2024 10:19 AM |
| 2021-04-05_Utah_Medicaid_Initial_Wheelchair_Evaluation_Form.pdf |
2021-04-05_UTAH_MEDICAID_INITIAL_WHEELCHAIR_EVALUATION_FORM.PDF File |
1,444,972 |
Apr 22 2024 10:19 AM |
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781,303 |
Dec 29 2023 11:04 AM |
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349,118 |
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118,280 |
Sep 21 2022 8:35 AM |
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AUTHORIZATION_DISCLOSEPHI2018.PDF File |
36,388 |
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20,691 |
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| CONSENTIMIENTO PARA LA ESTERILIZACIÓN.pdf |
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131,432 |
Sep 21 2022 8:35 AM |
| Client_request_PHI2018.pdf |
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17,453 |
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| CombiningAdmission.pdf |
COMBININGADMISSION.PDF File |
80,508 |
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128,589 |
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90,688 |
Aug 10 2023 9:19 AM |
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298,285 |
Sep 21 2022 8:35 AM |
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11,470 |
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15,226 |
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15,122 |
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237,216 |
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32,332 |
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256,892 |
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142,567 |
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213,878 |
Sep 22 2023 4:10 PM |
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187,128 |
Sep 21 2022 8:35 AM |
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31,384 |
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277,327 |
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ICF FREEDOM OF CHOICE ACKNOWLEDGEMENT.PDF File |
75,114 |
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| ICF and Community Supports Waiver FACT sheet.pdf |
ICF AND COMMUNITY SUPPORTS WAIVER FACT SHEET.PDF File |
135,719 |
Sep 21 2022 8:35 AM |
| Medicaid Final Wheelchair Evalaution Form.pdf |
MEDICAID FINAL WHEELCHAIR EVALAUTION FORM.PDF File |
193,675 |
Apr 22 2024 10:19 AM |
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199,924 |
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224,666 |
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391,907 |
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269,029 |
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427,323 |
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238,104 |
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161,280 |
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| ProviderAgreement.pdf |
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| eMIPP_Coversheet_09152016.pdf |
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