dma-5052 NOTICE: YOUR ESTATE IS SUBJECT TO MEDICAID RECOVERY
| Form Number | dma-5052 |
| Medicaid Form Number | dma-5052 |
| Agency/Division | Health Benefits/NC Medicaid (DHB) |
| Form Effective Date | 2018-09-03T14:20:00-04:00 |
| Form File | DMA-5052_en.pdf |
| Form Number | dma-5052 |
| Medicaid Form Number | dma-5052 |
| Agency/Division | Health Benefits/NC Medicaid (DHB) |
| Form Effective Date | 2018-09-03T14:20:00-04:00 |
| Form File | DMA-5052_en.pdf |