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DSHS Form 05-255 CA Medicaid Transformation Demonstration Notice of Action Exception to Rule - Washington (Cambodian)
This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington.
The document is provided in Cambodian. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DSHS Form 05-255?
A: DSHS Form 05-255 is a document used by the Washington State Department of Social and Health Services.
Q: What is CA Medicaid Transformation Demonstration?
A: CA Medicaid Transformation Demonstration is a program in Washington State that aims to transform Medicaid services.
Q: What is a Notice of Action?
A: A Notice of Action is a document that provides information about changes to an individual's Medicaid benefits.
Q: What does Exception to Rule mean?
A: Exception to Rule refers to a specific situation where an individual may be granted an exception to the usual Medicaid eligibility rules.
Q: Who is this form for?
A: This form is intended for individuals who speak the Cambodian language and receive Medicaid services in Washington State.
Form Details:
- Released on May 1, 2017;
- The latest edition provided by the Washington State Department of Social and Health Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
Download a printable version of DSHS Form 05-255 CA by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
