MATP ELIGIBILITY Quick Reference Guide
PM 81 Blind Disabled Adult Child w/Buy-In Y PM 84 Blind Pickle Indv Y PM 85 Blind Disable Emp Indv Y PM 86 Blind QDWI Indv N PMN 00 Blind Long Term Care (NMP) N PMN 66 Blind Long Term Care w/Buyin NMP N PMN 80 Blind Long Term Care w/Buyin NMP N PMW 00 Blind Waiver Program (NMP) Y
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matp.pa.govIncident Report Form Template . MATP I. NCIDENT . R. EPORT. N. AME OF INVOLVED PERSON _____ A. DDRESS
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COMMONWEALTH OF PENNSYLVANIA
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matp.pa.govPhone #: Last Name: First Name: I hereby certify that to the best of my knowledge, the medical trip information listed on the back of this form is true, correct, and complete.
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matp.pa.gov5 At the Keystone Key page (above), enter SeGov Username and Password. Click Login DPW USER AGREEMENT The Reset Password functionality verifies that the User Agreement is on file with Active Directory (AD) maintained by the …
Verification of Disability or Special Needs - …
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