RAISE THEM HIGH, inc
RAISETHEMHIGH, inc

Deeming Waiver Forms

Intake Form
Child Intake Form.docx
Microsoft Word document [193.8 KB]
Form 94 - Medicaid Application
This form is for New Applicants for the Deeming Waiver
1App MedicaidNewOne.pdf
Adobe Acrobat document [133.4 KB]
Form 222 - Medicaid Renewal Application
This is the Medicaid Renewal for the Deeming Waiver
30App Forms Renew 222.doc
Microsoft Word document [113.5 KB]
HIPPA Application
Each parent must sign a HIPPA Form for the Deeming Waiver
C HIPPA Form.docx
Microsoft Word document [46.8 KB]
DMA 285 - Health Insurance Information Questionnaire
This must be completed and added to the Medicaid Application for the Deeming Waiver
3 TPL DFCS Form copy 285.pdf
Adobe Acrobat document [57.2 KB]

For your convenience here are forms that you can download and complete.  If you have problems, please, let us know.

 

 

Contact Us Today!

Raise Them High, inc.

Phone:

678-313-1527

E-mail: 

abg5519@gmail.com

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We are not defined by what we do for ourselves, but by what we do for others.