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Owner: Health and Social Services, Social Services
Link: http://dhss.delaware.gov/dss/files/chip_appl_engl.txt
Referring Page - Publications and Forms
Description: Complete and sign this application form to apply for the Delaware Healthy Children Program,
which offers affordable health insurance to uninsured children. You will pay a low monthly
premium based on family income.
You can also use this form to apply for Medicaid's Diamond State Health Plan for individuals and
families.
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The file type of this form is not recognized. Please consult the agency listed above for information about files with a .txt extension.
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Last Updated: Thursday, 24-Jul-2008
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