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CSHCS Important Payment
Information

Item#HP-M124E

    This form provides important information about the Children's Special Health Care Services (CSHCS) Payment Agreement, the Authorization to Disclose Protected Health Information and information required for court-appointed guardians for CSHCS clients.

    • Intended Health Department Use Only
    • Weekly order limit of 25 pieces
    • Rev. Date 08/2016
    • 8.5" x 11" single sided handout



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    1 $0.00

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