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Get Tn Tc-0159 2015-2025

DATE: I certify that the applicant s medical condition on the recertified PAE is consistent with that described in the initial certification (above) and that Nursing Facility services are medically necessary for the applicant. Must be SIGNED by a Physician (MD or DO), Nurse Practitioner, Physician Assistant, or Clinical Nurse Specialist Recert PAE Request Date TC-0159 Signature and Credentials TennCare LTSS Update: 10/2015 Date of Signature RDA 2047.

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