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RNAROUND CANCEL REOPEN ORIG-ID: RECERTIFY COVERAGE *HOH/CASE-NUM: *CURR-ID: CARES-IRN: *NAME SSN: *HOH NAME: *APPL DATE: MEDICARE –NUM: *ADDR: ADDR: *DEC-DT: *CITY: *STATE: *BIRTH: *ZIP: MD *RACE: PHONE: *SEX: HOSP-NUM: *RES-CNTY: DT-OF-ENTRY: CITZ-IDEN: DIST-OFF: UNIT: VCN: *REQUIRED FOR ADD DEATH: ISSUE-DT: REQUIRED FOR QMB ELIGIBILITY SPAN BEGIN DATE REASON FOR DOCUMENT: END DATE COV GROUP COV TYPE CAT MARYLAND KIDS COUNT OUTSIDE OF CARES SCP SPLIT AMT .

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