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MISSISSIPPI payment procedures in these situations. 3. From county health departments, Vocational Rehabilitation counselors, etc. 4. For Veterans Administration Hospitals, obtain a release from the individual, either on the regular form provided by the hospital or in the form of a letter or written statement over the individual's signature, giving his full name, address, social security and

Volume III | Chapter 3 FINANCIAL CRITERIA: DEPRIVATION]

Revised 08-01-06

veteran's claim number and send this request to the appropriate hospital. 5. From other agencies with whom special agreements have been worked out. There are several agencies or medical facilities with which the Department has agreements for exchange of medical information. These are the University Medical Center, Jackson, Mississippi; East Mississippi State Hospital, Meridian, Mississippi; Mississippi State Hospital, Whitfield, Mississippi; and Regional Mental Health Centers. The Medical Review Unit will accept medical information from the sources named above when the applicant for or recipient of TANF has been examined or treated in the facility within twelve months prior to the current date. Follow the procedures below for requesting medical information.

University Medical Center, Jackson. Use form MDHS-EA-333, Request to Cooperating Medical Facilities for Information, to request medical information from a UMC out-patient clinic or from the hospital regarding treatment or examination. Give complete identifying patient information including the patient ID number, and include a stamped, addressed return envelope. NOTE: The University Hospital cannot accept patients for examinations for determining eligibility on incapacity using the MDHS-EA-331, Report of Medical Examination. ∙ Mississippi and East Mississippi State Hospitals. Request medical information from either of these hospitals by use of form MDHS-EA-333 when the individual has been treated within the previous twelve months. Otherwise, obtain a current report from a