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Attachment V MA Only LDSS-3869 (9/10) NOTICE OF DECISION ON REIMBURSEMENT OF MEDICAL BILLS BY THE MEDICAL ASSISTANCE PROGRAM NOTICE DATE: NAME AND ADDRESS OF AGENCY/CENTER OR DISTRICT OFFICE CASE
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What is notice of decision on?
The notice of decision on is a formal document that informs individuals or organizations about a decision that has been made.
Who is required to file notice of decision on?
The party who made the decision or the party who is affected by the decision is required to file the notice of decision on.
How to fill out notice of decision on?
The notice of decision on should be filled out with the relevant details of the decision, including the date, decision maker, and the reasons for the decision.
What is the purpose of notice of decision on?
The purpose of the notice of decision on is to communicate a decision to the parties involved and to provide a written record of the decision.
What information must be reported on notice of decision on?
The notice of decision on must include the date of the decision, the decision maker, the reasons for the decision, and any actions required by the parties.
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