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Mileage Reimbursement 2017-01-01 - Pennsylvania
Phone #: 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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Documents from same domain
Incident Report Form Template - Pennsylvania
matp.pa.govIncident Report Form Template . MATP I. NCIDENT . R. EPORT. N. AME OF INVOLVED PERSON _____ A. DDRESS
INSTRUCTIONS REQUIREMENTS - Pennsylvania
matp.pa.govCOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE OFFICE OF MEDICAL ASSISTANCE PROGRAMS MEDICAL ASSISTANCE TRANSPORTATION PROGRAM INSTRUCTIONS REQUIREMENTS Prepared by the Division of Medical Assistance Transportation Programs
MATP ELIGIBILITY Quick Reference Guide
matp.pa.govMATP ELIGIBILITY Quick Reference Guide If the consumer's eligibilty shows two categories, as long as one of the codes is showing eligible; then the consumer is
PA Department of Public Welfare Frequently Asked …
matp.pa.govPA Department of Public Welfare Frequently Asked Questions on Methadone Treatment in MA and MATP _____ heroin use.
COMMONWEALTH OF PENNSYLVANIA
matp.pa.govCOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES OFFICE OF MEDICAL ASSISTANCE PROGRAMS MEDICAL ASSISTANCE TRANSPORTATION PROGRAM STANDARDS GUIDELINES Prepared by the Division of Medical Assistance Transportation Programs
Recipient Identification General Transportation …
matp.pa.govYes No Yes No Yes No Yes No I don't know; Yes No Yes No Yes No Yes No Yes No Yes No Do you live 1/4 mile or less from a bus route?
SeGOV User Guide - Pennsylvania
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 - …
matp.pa.govLimitations These Limitations Apply Status Indicate the tasks (below) related to using public transit that the individual listed above cannot do.
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