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Spokane Valley Washington Form 851: What You Should Know

Office can be contacted at. Eligibility for assistance is determined by the following: a. The deceased did not receive a medical certification as a result of a traumatic head injury/stroke/trauma that was  related to and caused by the exposure to a contaminated substance.  b. The deceased was eligible under state or federal law to receive medical assistance for a medical condition that qualifies for Medicaid. c. The deceased was eligible for the program of public assistance in the community where the deceased resided.  e. The deceased received services under a state or federal program for the prevention, investigation, or treatment of infectious diseases or diseases. f. The deceased receives benefits under the Public Welfare Services Act by receiving public assistance benefits under state or federal laws.  g. The deceased does not have another eligibility under state or federal law that the Medical Office of the Spokane County Health Department finds more likely  than any other. A person who wishes to request assistance is required to complete an application form and provide medical evidence of  the qualifying disease (or condition) and a physician's statement confirming, under penalty of perjury, that the person meets the  requirements of this statute. There is a 25 application fees and a 20 processing fee to be paid to the Office of Health Services.   Applications are due on the 15th day of the 3rd month following the year of death. Applications must include medical  evidence of the qualifying disease or condition and a physician's statement confirming, under penalty of perjury, that  the person meets the requirements of this statute. All applicants are required to take an oral examination in order to determine eligibility for help. All applicants must sign an Application for Aid in Dying and must provide written certification before the examination. Applies for medical assistance. Application is for help in dying. Applications for aid in dying must be accompanied by: a. A completed Application for Aid in Dying and a signed statement in the form of a written statement by a  physician or other medical specialist that the applicant is of sound mind in all respects and that the applicant's life is not ending within 90 days of the application. b. A document of the applicant's spouse or next of kin. c. A copy of the death certificate(s). d. Evidence of the applicant's financial independence. e.

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