Get Co Ultc 100.2 2020-2025

The CO ULTC 100.2 form is a crucial document for individuals seeking long-term care benefits. This guide provides clear instructions on how to complete the form online, ensuring that users can accurately fill out each section with confidence.

Follow the steps to effectively complete the CO ULTC 100.2 online.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by filling out the screening agency and referral completion date at the top of the form. Include the screener's name and date in the 'Month/Day/Year' format.
3. Complete the assessing agency section by providing the assessor's name and their identification numbers, including provider number and worker number.
4. Indicate the current living situation by selecting one of the options available, such as 'Alone', 'With Spouse/Others', or 'With Parents'. If applicable, check any urgent situations.
5. In the applicant information section, provide the state ID, primary language, last name, first name, address, county ID, middle initial, date of birth, marital status, Social Security Number, city, state, zip code, and phone number.
6. Describe the presenting problems and diagnoses in the comments section, followed by identifying areas of concern like bathing, dressing, and memory.
7. Select relevant potential community-based long-term care programs that apply to the applicant. You can also specify any other program in the provided space.
8. Complete the sections regarding residential alternatives, information and referral provided, and contact information of the referring party.
9. Fill in the financial information by detailing income sources for both the client and their spouse, recording the amounts accurately.
10. Provide the client's insurance information, including benefits and applications pending or needed.
11. Complete the medical provider information section, stating the provider’s name, address, and type of provider and ensuring the contact person and comments are filled out.
12. Finish by certifying that the information is accurate and complete, and sign the document either by the client or their representative, adding the date.
13. Once all sections are filled out, you can save changes, download, print, or share the completed form online.

Take the next step to ensure your long-term care needs are addressed by completing the CO ULTC 100.2 online today.