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Get Wi Dhs F-20418 2010

DEPARTMENT OF HEALTH SERVICES Division of Long Term Care F-20418 04/2010 STATE OF WISCONSIN AGENCY APPLICATION FOR ACCESS TO WEB-BASED PERSONAL CARE SCREENING TOOL Completion of this form is voluntary. Failure to complete this form may result in a delay in gaining access to the web-based Personal Care Screening Tool. Application may only be submitted by Medicaid Certified Personal Care Provider. Agencies List agency name and contact information f.

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