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Briva Health Enrollment App
Please complete this form and a MNsure Certified Navigator from Briva Health will contact you to help you finalize and submit your MA renewal documents to your county
Household Info
Language
English
Language
First Name
First Name
Middle Name
Middle Name
Last Name
Last Name
Birth Date (mm/dd/yyyy)
Birth Date (mm/dd/yyyy)
Marital Status
Marital Status
Cell Phone
Cell Phone
Street Address
Street Address
City
City
State
State
Zip Code
Zip Code
County
County
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