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Developmental Disabilities Administration Home and Community-Based Services Waiver for Individuals with Freedom of Choice Form Waiver Community Pathways New Directions Individual s Name Please check your choice in services to be received I choose to receive home and community-based services under the Maryland Medical Assistance Program /DDA Waiver indicated above.
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What is blank ltc dom of?
Long-term care Declaration of Ownership and Management (DOM) Form is a document that is used to declare the ownership and management information of long-term care facilities.
Who is required to file blank ltc dom of?
Long-term care facility owners and operators are required to file the blank LTC DOM Form.
How to fill out blank ltc dom of?
To fill out the blank LTC DOM Form, you need to provide the necessary ownership and management information of the long-term care facility, such as the names of the owners, facility address, contact details, and other relevant information.
What is the purpose of blank ltc dom of?
The purpose of the blank LTC DOM Form is to collect and report accurate ownership and management information of long-term care facilities for regulatory and compliance purposes.
What information must be reported on blank ltc dom of?
The blank LTC DOM Form requires the reporting of ownership details, including names and addresses of owners, management information, facility information, and other relevant details as specified in the form.
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