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WTC Health Program Responder Eligibility Application (
The VCF requires individuals applying to the program to sign an authorization form permitting DOJ to request and share protected health information and/or
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wtc health program online application signature form |
If this form is to be signed by an individual with legal guardianship for the applicant, the WTC Health Program must have a court order appointing guardianship
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Provider Manual
Jan 26, 2021 Questionnaire Form; 2) Instructions for Physicians; 3) Diagnosis Form and 4) a HIPAA Form. WTC. Email: pr.west@healthsmart.com. Fax: 214.574
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