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The document is a form from the Wisconsin Department of Health Services that authorizes a representative to act on behalf of an applicant for Medicaid, BadgerCare Plus, or FoodShare. It outlines the responsibilities and legal requirements for both the applicant and the authorized representative, including the need for signatures and witness verification. The form emphasizes the importance of providing truthful information and details potential penalties for fraudulent claims.

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Send sheetz employee handbook pdf via email, link, or fax. You can also download it, export it or print it out.

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