dma-5045 Certification of Need For Institutional Care for Individual Under Age 21
| Form Number | dma-5045 |
| Medicaid Form Number | dma-5045 |
| Agency/Division | Health Benefits/NC Medicaid (DHB) |
| Form Effective Date | 2019-01-22T15:05:00-04:00 |
| Form File | dma-5045.pdf |