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COMAR 10.09.24.15
1526
State of Maryland Medical Assistance Manual Revised July 2012
Signature – Eligibility Technician
Local Department of Social Services
Printed Name – Case Manager
Telephone Number Date
Signature- Supervisor
Telephone Number Date
DHMH 1159C (LTC) Revised 03/09 White-Division of Recoveries Copy
Yellow-Case Record Copy
Attachment G Lien Memorandum
MARYLAND MEDICAL ASSISTANCE PROGRAM LIEN MEMORANDUM
Date:
TO:
FROM:
SUBJECT: