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| Assigned Number | Title | Other Location |
|---|---|---|
| F-62281 | Care Level Change Notice | None |
| F-62372 | Community Based Residential Facility (CBRF) Resident Satisfaction Evaluation | None |
| F-01556C | IRIS Program Cost Share Repayment Plan Letter | None |
| F-62381 | Residential Care Apartment Complex (RCAC) Regulations Compliance Statement | None |
| F-62224 | Nurse Aide Training Program – Notice of Substantial Change | None |
| F-01442F | IRIS Program Disenrollment Letter – Missing Signature Page | None |
| F-01442i | IRIS Program Disenrollment Letter - Cancelled | None |
| F-01319C | IRIS Program – Denial of Enrollment Letter | None |
| F-01454E | IRIS Program Withdrawal Letter – Voluntary | None |
| F-01204C | Letter - IRIS Program Notice of Action - Reduction | None |
| F-01442G | IRIS Program Disenrollment Letter – Non-Spending | None |
| F-01442J | IRIS Program Disenrollment Letter - Mismanagement | None |
| F-01468 | IRIS Program Start Date Letter – New Participant | None |
| F-01442 | IRIS Disenrollment Letter - Death | None |
| F-01204D | Letter - IRIS Program Notice of Action - Termination | None |
| F-01942A | LTC FS - Diagnosis Verification Letter | None |
| F-01454 | IRIS Program Withdrawal Letter – No Progress | None |
| F-01442H | IRIS Program Disenrollment Letter – Voluntary | None |
| F-01442K | IRIS Program Disenrollment Letter - Policy Noncompliance | None |
| F-01293B | Fiscal Employer Agent (FEA) Change Denial Letter | None |
| F-01468A | IRIS Program Start Date Letter – Transferring Participant | None |
| F-01204F | IRIS Program Notice of Action Letter – Denied Provider Change | None |
| F-01442A | IRIS Program Disenrollment Letter – Financial Eligibility | None |
| F-01204E | Letter - IRIS Program Notice of Action - Functional Eligibility | None |
| F-01942B | LTC FS - Request Letter | None |
| F-01454A | IRIS Program Withdrawal Letter – Financial or Functional Eligibility | None |
| F-01942 | Long-Term Care Functional Screen (LTC-FS) - Annual Deadline | None |
| F-01442D | IRIS Program Disenrollment Letter – Incomplete Functional Screen | None |
| F01454G | IRIS Program Withdrawal Letter - Cancelled | None |
| F-01293C | Fiscal Employer Agent (FEA) Change Effective Date Letter | None |
| F-01352A | IRIS Participant-Hired Worker Background Check Appeal Process Letter | None |
| F-01442B | IRIS Program Disenrollment Letter – Functional Eligibility | None |
| F-01942C | LTC FS - Release of Information Authorization | None |
| F-01454B | IRIS Program Withdrawal Letter – Health and Safety | None |
| F-01352B | IRIS Participant-Hired Worker Background Check Appeal Process - Ineligible Letter | None |
| F-01442C | IRIS Program Disenrollment Letter – No Contact | None |
| F-01942D | LTC FS - Change in Condition - Release of Information Authorization | None |
| F-01454C | IRIS Program Withdrawal Letter – No Contact | None |
| F-01442E | IRIS Program Disenrollment Letter – Ineligible Setting | None |
| F-01454F | IRIS Program Withdrawal Letter - Death | None |
| F-01454D | IRIS Program Withdrawal Letter – Non Eligible Setting | None |
| F-01204B | Letter - IRIS Program Notice of Action - Limit | None |
| F-00565 | County Performance Plan (CPP) | None |
| F-00565A | County Performance Plan (CPP) Goals | None |
| F-01204A | Letter - IRIS Program Notice of Action - Denial | None |
| F-25615 | Supervised Release Rules | None |
| F-02209 | Program Integrity Annual Survey – Health Maintenance Organizations (HMOs) | None |
| F-80025 | Forms / Publications Order | None |
| F-44815 | Immunization Program Orders (Medical Authorization), Policy and Procedure Approval, and Indemnification | Other |
| F-11285 | HealthCheck Screener Affirmation | None |
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Last Revised: May 22, 2018
