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Get Oh Waiver Documentation For Homemaker/personal Care Services - Geauga County 2016-2024

Ut Total # of Units 1:1 ratio, unless otherwise noted Supports in Plan Duration / Frequency SERVICE MONTH: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 YEAR: 18 19 20 21 22 23 24 25 26 27 28 29 30 31 *ALL SERVICES ARE PROVIDED IN THE PERSON S HOME UNLESS OTHERWISE NOTED BELOW. DATE R Refused service. Service locations if other than home, problems delivering services, refusal, unusual incidents & reasons, etc. SIGNATURE: Prepared by SS 05112016.

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