Medicaid for Breast and Cervical Cancer Medicaid para el ... - DADS - dads state tx 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the applicant's name (first, middle, last) in the designated fields.
3. Fill in the Social Security Number and Date of Birth (mm/dd/yyyy) accurately.
4. Provide your home address, including street, city, ZIP code, and county. If your mailing address differs, complete that section as well.
5. Indicate your ethnicity and race if you choose to do so; these fields are optional.
6. Answer the citizenship questions truthfully. If applicable, prepare to submit proof of citizenship or legal immigration status.
7. Complete the health insurance section by providing details about any existing coverage related to breast or cervical cancer treatment.
8. Review all information for accuracy before submitting. Ensure you sign and date the application at the end.

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