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STATE OF MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF LICENSING AND REGULATORY SERVICES Medical Use of Marijuana Program Caregiver Application SECTION 1: Caregiver Information New Applicant
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How to fill out section 1 caregiver information:

01
Start by providing your full name. Write it exactly as it appears on your identification documents.
02
Next, fill in your current address. This should include the street, city, state, and zip code.
03
Provide your contact information. This includes your phone number and email address. Make sure to double-check the accuracy of this information.
04
Indicate your relationship to the person you are caring for. Select the appropriate option from the provided choices, such as parent, spouse, or other relative.
05
Specify the length of time you have been providing care to the individual. This can be indicated in months or years.
06
If you are receiving compensation for your caregiving services, indicate the amount received. If you are not receiving any compensation, leave this section blank.
07
Finally, sign and date the caregiver information section to certify that all the information provided is accurate.

Who needs section 1 caregiver information?

01
Individuals who are applying for government assistance programs that require caregiver information.
02
Employers or organizations that require caregiver information for payroll or benefits purposes.
03
Medical professionals who need caregiver information in order to provide appropriate care and support to their patients.
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Section 1 caregiver information is a part of a form or document that collects details about the primary caregiver of a dependent individual.
Any individual or entity responsible for the care of a dependent individual may be required to file section 1 caregiver information.
To fill out section 1 caregiver information, one must provide details such as name, contact information, relationship to the dependent individual, and any relevant medical or caregiving experience.
The purpose of section 1 caregiver information is to ensure that the dependent individual receives appropriate care and support from qualified caregivers.
Information such as name, contact details, relationship to the dependent individual, medical history, caregiving experience, and any relevant certifications or qualifications must be reported on section 1 caregiver information.
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