WebComplete MI DHS-4574 2016-2024 online with US Legal Forms. Easily fill out PDF blank, edit, and sign them. Save or instantly send your ready documents. WebAUTHORITY COMPLETION PENALTY DHS-4574 Rev. 5-16 Previous edition obsolete. 42 CFR PART 435. Voluntary. FOR OFFICE USE ONLY Beneficiary Name APPLICATION FOR HEALTH CARE COVERAGE PATIENT OF NURSING FACILITY Client ID Michigan Department of Health and Human Services Case Number HELP IS AVAILABLE County …
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