109-8          TEMPLATES

Addendum C - H include the current standardized CANO Case Notes templates for:

1. • Addendum C - Report of Change, Examples, and Report of Change Guide

   • Addendum D - Medicaid Citizenship and Identity

   • Addendum E - Transitional Medicaid (12 Month Continuous Eligibility Period)

   • Addendum F - Fair Hearing Request

   • Addendum G - Prehearing Conference

   • Addendum H - Fraud Referral and Findings