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Must fall within 0% to 150% of the Federal Poverty Level Guidelines and/or be disabled. A minimum of 24 hours notice is required for any changes in transportation. Initial information obtained in this document, and subsequent information obtained upon annual review will be subject to verification. In the event that the individual requires emergency care, information contained in this document must be provided to EMS and/or hospital as needed. Instructions: Complete all sections. If a section d.

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