dma-5010-ia Referral for Inpatient Hospital and Intermediate Care Facility in State Mental Hospital/State Mental Retardation Centers

Medicaid Form Numberdma-5010-ia
Agency/DivisionHealth Benefits/NC Medicaid (DHB)
Form Effective Date 2002-02-27T11:00:00-05:00
Form File dma-5010-ia.pdf