The following form used by the Department in its dealings with the public is listed as follows and is hereby adopted and incorporated by reference, and can be obtained from the Department office by writing to the Department of Health, Family Health Services, 4052 Bald Cypress Way, Bin #A-13, Tallahassee, FL 32399. DH 3212, entitled “”Health Insurance Application for Extended Family Planning Benefits,”” (11/06).
Rulemaking Authority 154.011, 381.0011(13), 381.0051(7) FS. Law Implemented 154.011, 381.0051 FS. History-New 8-9-04, Amended 2-17-08.