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STATE OF WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES MEDICAL REVIEW TEAM (MRT) MEDICAL INFORMATION / DIAGNOSTIC REQUEST Case Name: MA ID/Pending Medicaid No.: Patient s Name: Patient s
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Form - dfa-rt-6 is a specific document used for reporting tax information to the Department of Finance and Administration.
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Form - dfa-rt-6 requires reporting of income, expenses, deductions, and other relevant tax information.
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