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Click ‘Get Form’ to open it in the editor.
Begin by entering the required information in the personal details section, including the child's name, age, and guardian's contact information. Ensure accuracy as this data is crucial for follow-up.
Proceed to the enrollment status section. Select whether the child is a new enrollee, established enrollee, or recent disenrollee based on their current situation with SCHIP or Medicaid.
In the health services access section, provide details about the child's experience with healthcare services. This includes frequency of visits and any barriers faced during enrollment.
Review all entered information for completeness and accuracy before submitting. Utilize our platform’s editing tools to make any necessary adjustments easily.
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