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P.O. Box 3599 Topeka, KS 666019738 Phone: 18007924884MEDICAL SUBROGATION REFERRAL Adoption: Office of the Fiscal Agent TPL Department P.O. Box 3571 Topeka, KS. 666013571 Fax: 7852745918 1. Case Number:From:Name:
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Gather all required information and documents such as personal details, income proof, and any other relevant information.
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04
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Individuals who require extra help with Medical Services Plan (MSP) expenses in a large-print format may need the msp-extra-help-fact-sheet----large-printpdf. This format is designed to assist individuals with visual impairments or other accessibility needs in understanding and accessing the help available to them.
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It is a fact sheet in large print format providing extra help information for the MSP program.
Individuals who are eligible for the MSP program and require extra help must fill out and file the fact sheet.
The fact sheet must be filled out with accurate information regarding the individual's eligibility for extra help under the MSP program.
The purpose of the fact sheet is to provide information about the extra help available to individuals under the MSP program.
The fact sheet must include personal information, income details, and information about the individual's need for extra help under the MSP program.
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