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REQUEST FOR DIRECT SUPPORT or Specialty Provider ServicesIdentified Provider: Date of Referral: Member Information Youths Name Date of Birth: Age: Member ID Number: Youths Physical Address: Phone:

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What is request for direct support?

Request for direct support is a formal appeal or plea for assistance or help in a specific situation.

Who is required to file request for direct support?

Any individual or organization in need of direct support is required to file a request for direct support.

How to fill out request for direct support?

To fill out a request for direct support, one must provide detailed information about the situation requiring assistance, contact information, and any supporting documentation.

What is the purpose of request for direct support?

The purpose of a request for direct support is to formally ask for assistance or help in a specific situation where direct support is needed.

What information must be reported on request for direct support?

Information such as the nature of the assistance needed, the reasons why direct support is necessary, contact information, and any supporting documentation must be reported on a request for direct support.

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