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FAX to: 2066138873APPLE HEALTH (MEDICAID)MEDICARE ADVANTAGECASCADE SELECT ABA Therapy Initial Request Form Service Call: Apple Health (Medicaid) 18004401561 CHNWCascade Select 18669071906Member Name Date
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How to fill out selecformalth medical ampamp dental

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Obtain a selecformalth medical and dental form from your healthcare provider or employer.
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Provide information about your medical history, such as any pre-existing conditions, medications you are currently taking, and any allergies you have.
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