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DDRS Waiver Manual

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Signature Page<br />

Subject: <strong>DDRS</strong> <strong>Waiver</strong> <strong>Manual</strong><br />

My signature below is an acknowledgement that I have received a link to, or, upon my<br />

request, a hard copy of, the Division of Disability & Rehabilitative Services’ <strong>DDRS</strong> <strong>Waiver</strong><br />

<strong>Manual</strong><br />

<strong>DDRS</strong> <strong>Waiver</strong> <strong>Manual</strong> delivery acknowledgement:<br />

Individual <strong>Waiver</strong> Participant’s HIPAA Name (Print)<br />

Recipient’s relationship to Individual <strong>Waiver</strong> Participant (Print)<br />

<strong>DDRS</strong> <strong>Waiver</strong> <strong>Manual</strong> Recipient’s Name (Print)<br />

<strong>DDRS</strong> <strong>Waiver</strong> <strong>Manual</strong> Recipient’s Signature<br />

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