Form DOH-5247SC Medicaid Authorized Representative Designation / Change Request - New York (Chinese)

This is a legal form that was released by the New York State Department of Health - a government authority operating within New York.

The document is provided in Chinese. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

• Released on November 1, 2017;
• The latest edition provided by the New York State Department of Health;
• Easy to use and ready to print;
• Quick to customize;
• Compatible with most PDF-viewing applications;

Download a printable version of Form DOH-5247SC by clicking the link below or browse more documents and templates provided by the New York State Department of Health.