Form DOH-5247HC Medicaid Authorized Representative Designation / Change Request - New York (Haitian Creole)

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 Haitian Creole. 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 fillable version of Form DOH-5247HC by clicking the link below or browse more documents and templates provided by the New York State Department of Health.