Pa 1768 form 2010-2025

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The document is a form for Home and Community Based Services (HCBS) that outlines eligibility, ineligibility, and changes in status for applicants or recipients. It includes sections for demographic information, assessment details, agency information, and various scenarios such as moving, program transfers, or termination of services. The form serves to verify the individual's level of care and facilitate the application process for HCBS.

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