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ATTACHMENT 3: SAMPLE AGREEMENT FOR PROFESSIONAL SERVICES COUNTY MEDICAL SERVICES PROGRAM (CSP) LOCAL INDIGENT CARE NEEDS (LION) GRANT PROGRAM CONSULTANT SERVICES THIS AGREEMENT (Agreement) is made
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How to fill out county medical services program

01
Step 1: Gather all relevant documents such as your identification proof, income proof, residency proof, and any medical records that may be required.
02
Step 2: Contact your local County Medical Services Program office to inquire about the application process and to schedule an appointment if necessary.
03
Step 3: Fill out the application form with accurate and complete information. Provide all necessary details about your income, expenses, and household members.
04
Step 4: Attach all the required documents along with the application form. Make sure to provide all supporting documents to validate your eligibility.
05
Step 5: Submit the completed application form and supporting documents to the County Medical Services Program office either in person, by mail, or online if applicable.
06
Step 6: Wait for the program office to process your application. They may contact you for any additional information or documentation if needed.
07
Step 7: Once your application is approved, you will receive a notification detailing the coverage and benefits you are eligible for under the County Medical Services Program.

Who needs county medical services program?

01
The County Medical Services Program is designed for individuals who are low-income, uninsured, and do not qualify for other public health insurance programs such as Medicaid or Medicare.
02
It is especially beneficial for individuals who have medical conditions or require ongoing medical treatment but cannot afford private health insurance or medical expenses.
03
The program aims to provide essential healthcare services to those who need it the most and lack access to adequate medical coverage.
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The County Medical Services Program (CMSP) is a program that provides medical assistance to low-income individuals and families who do not qualify for other state health programs.
Individuals who do not have access to other forms of health insurance and meet the income and residency requirements set by the county are required to file for the County Medical Services Program.
To fill out the County Medical Services Program application, individuals must gather necessary documents, complete the application form provided by the county, and submit it along with required documentation, such as proof of income and residency.
The purpose of the County Medical Services Program is to ensure that low-income individuals and families have access to essential medical services when they do not qualify for other health coverage.
Applicants must report personal information including their name, address, income, household size, and any other relevant personal or financial information as required by the county.
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