Medicaid Application and Redetermination process.
Request Form (pdf), IL444-3610 S FORMULARIO DE SOLICITUD DE PRUEBA DE IDENTIDAD DEL ESTADO (pdf) . and proof documents (listed on page 3 of the form). If an Approved Representative is completing the form, a signed . Approved Representative FormMUST be mailed along with the Request form, and Proof Document, even if one is already on file with the State. Proof documents - you will … ................
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