DHB-5009 Social History Summary For The Disabled
| Medicaid Form Number | DHB-5009 |
| Agency/Division | Health Benefits/NC Medicaid (DHB) |
| Policy Program | Medicaid Aged, Blind, Disabled |
| Form Effective Date | 2022-11-01T12:40:43-04:00 |
| Form File | DHB-5009.pdf |
| Medicaid Form Number | DHB-5009 |
| Agency/Division | Health Benefits/NC Medicaid (DHB) |
| Policy Program | Medicaid Aged, Blind, Disabled |
| Form Effective Date | 2022-11-01T12:40:43-04:00 |
| Form File | DHB-5009.pdf |