maryland 340 form
TDAP 340 Form
The state can use this form for one case situation at a time, either an initial claim or a post-eligibility case. If both blocks are checked the form is not.
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Family Investment Administration - ACTION TRANSMITTAL
Upon receipt of the DHR/FIA 340 form, the case manager signs and dates the. 340 form and: 1. Enters the date the customer signed the 340 form in the IAR date
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NEW YORK STATE MEDICAID PROGRAM ORDERED
BY REPORT: A service that is rarely provided, unusual, variable, or new may require a special report in determining medical appropriateness of the service
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