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APPLICATION FOR HEALTHCARE SAFETY NET EMERGENCY

APPLICATION FOR HEALTHCARE SAFETY NET EMERGENCY 2025

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The document outlines an application process for grants from the Tennessee Department of Health to provide emergency dental services to uninsured adults aged 19 to 64. It specifies eligibility criteria for applicants, including faith-based and community health centers, and details the requirements for service provision, reporting, and reimbursement. The focus is on ensuring access to dental care in medically underserved areas, with a sliding fee scale or reduced costs for services. The application must be submitted by July 16, 2012, and includes specific instructions for completion.

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Click ‘Get Form’ to open the APPLICATION FOR HEALTHCARE SAFETY NET EMERGENCY in the editor.
Begin with Section A: General Information. Fill in your Applicant Legal Entity Name, ensuring it matches your registration with the Tennessee Department of State. Provide details about your organization’s structure and responsibilities.
Continue by completing the DBA/Nickname, Type of Center, Corporate Status, and other required fields such as FEIN and State ID Number if applicable.
In Section B: Application Content, describe your dental center's setup, staffing structure, and emergency services offered to uninsured adults aged 19-64. Be specific about the number of extractions provided previously and any relevant methodologies for charging fees.
Ensure all sections are completed accurately before signing in Section D. Remember to submit four copies of the application by the specified deadline.

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How to apply for emergency Medicaid in NC?

States are required by federal law to approve or deny Medicaid applications within 45 days, or 90 days for applications that require a disability determination.

How to apply for emergency Medicaid?

The application process Begin by contacting your states Medicaid office or the hospital where treatment is sought. Many hospitals can help with the application process during an emergency. Youll need to provide documentation to prove eligibility, such as: Proof of income (e.g., pay stubs, tax returns).

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