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AUTHORIZED REPRESENTATIVE DESIGNATION FORM Commonwealth of Massachusetts EOHHSYou can submit this form if you would like to designate an authorized representative to act on your behalf. If an authorized

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To fill out the formsbenefitscheckuporgmaexpchmdcdschipmassachusetts application for health, follow these steps: 1. Visit the website formsbenefitscheckuporgmaexpchmdcdschipmassachusetts. 2. On the homepage, find the application form for health. 3. Click on the form and it will open in a new window. 4. Fill in your personal information, such as your name, address, date of birth, and contact details. 5. Provide information about your current health status and any medical conditions you may have. 6. Answer the questions about your income and financial situation. 7. Provide any additional documents or proofs required, such as income statements or medical reports. 8. Review your application and make sure all the information is accurate. 9. Submit the completed application.

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