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Medicaid Department of Health State of Louisiana
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For State Employees - The official website of Louisiana
WebEPSDT-PCS Form 90 1 Revised 11/01/10 REQUEST FOR MEDICAID EPSDT - PERSONAL CARE SERVICES (Personal Care Services are to be provided in the home and not in an institution) I. IDENTIFYING INFORMATION 1. Applicant Name: MID# Address: Ph # ( ) Male Female. DOB: 2. Responsible Party/Curator: Relationship: Address: Home … Web18 rows · May 31, 2024 · Online Forms or Files Description; 152N Newborn Eligibility Online Provider Form: Online form for certain hospital providers to electronically request and … WebIf you have questions regarding exclusions please email them to [email protected]. Effective October 1, 2024 ... State of … songs with theresa in the title