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If applying for the WIC Program, then Proof of Identity of Patient, Residency, and Income MUST BE PRESENTED at time of service.(PLEASE PRINT INFORMATION when completing the attached CH5B Form)#1.
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It is a form used to apply for a specific program or benefit.
Anyone who wishes to apply for the program or benefit.
You need to provide accurate and complete information requested on the form.
The purpose is to gather necessary information to determine eligibility for the program or benefit.
Personal information, income details, and any other relevant information requested on the form.
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