Get Designation Of Personal Representative, Form 470-3948 - Iowa ... - Dhs State Ia

Filling out the Designation of Personal Representative, Form 470-3948, is a crucial step for clients wanting to authorize a personal representative for specific services. This guide will help you to complete the form accurately and efficiently online.

Follow the steps to fill out the Designation Of Personal Representative form.

1. Click ‘Get Form’ button to access the document. This action will enable you to open the designations form for editing.
2. Fill in your name as the client in the designated field clearly marked at the top of the form.
3. Enter the date of your request in the appropriate section to indicate when you are completing the form.
4. Provide your complete mailing address, including street or P.O. Box, city, state, and zip code, in the specified form fields.
5. Input your Social Security number, patient number, or state ID as required to uniquely identify you.
6. Fill in your phone number in the designated area to enable communication regarding this designation.
7. Check all applicable programs that you are enrolled in, such as Medicaid or hawk-i, by marking the checkboxes next to each program.
8. Input your birth date to provide further personal identification information.
9. If applicable, indicate the facility involved by filling in the respective field.
10. In the section labeled 'To be completed by client', write the name of the designated personal representative you wish to authorize.
11. Specify the relationship of the personal representative to you by checking one of the options provided or writing in an alternative relationship.
12. Sign the document in the section labeled 'Client’s Signature' to validate your designation.
13. Record the date of your signature to finalize the document prior to submission.
14. After completing all fields, ensure to save the changes you made to the form, and you may download, print, or share the completed document as necessary.

Complete your document online today to ensure your personal representative is designated correctly.