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DEPARTMENT OF HEALTH SERVICES×STATE OF WISCONSIN Division of Medicaid Services F20980 (03/2017)ASSESSMENT / SUPPLEMENT TO THE LONG TERM CARE FUNCTIONAL SCREEN1. General Instructions Assessment/Supplement
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Assessment supplement to form is a additional form that provides extra information or details related to an original assessment form.
Individuals or businesses who need to provide additional information or corrections on their assessment form may be required to file an assessment supplement to form.
Assessment supplement to form can typically be filled out by providing the requested information in the designated sections of the form.
The purpose of assessment supplement to form is to ensure accurate and complete information is provided in relation to the original assessment form.
The specific information or details that must be reported on assessment supplement to form will vary depending on the nature of the original assessment form and the reason for filing the supplement.
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