Get the up-to-date Day Activity and Health Services (DAHS) - Form 3050-2024 now

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Physicians Certification. By signing the form, the physician certifies the person has a chronic medical condition as indicated, and care, monitoring or intervention by a licensed nurse as prescribed.
Form 3052 is completed for initial referrals for PHC and CAS, and for referrals for people whose initial medical need for services was temporary.
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