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ADRC COORDINATOR DATE: / / 1. APPLICANT/CLIENT NAME DATE OF BIRTH / / DHS CASE NO. DHS CLIENT NO. 2. TYPE OF REFERRAL: ADRC INITIAL DETERMINATION ADRC REDETERMINATION DATE LAST ADRC COMPLETED: / / 3. REFERRAL SOURCE: DHS: Division / Section / Unit Name of EW Phone No. Fax No. QUEST HEALTH PLAN: Name of Plan 4. Contact Person Phone No. Fax No. DHS 1127, MEDICAL HISTORY AND DISABILITY STATEMENT DHS 1128, DISABILITY REPORT DHS 1147, SUB-ACUTE/LONG TERM.

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What are the Hawaii QUEST asset limits? $2,000 for a household of one; $3,000 for a household of two; $250 for each additional person.

Medicaid is a joint federal-state program that provides health coverage or nursing home coverage to certain categories of individuals, including children, pregnant women, parents of eligible children, low income adults, former foster care children, aged, blind and disabled individuals.

QUEST Integration provides Medicaid State Plan benefits and additional benefits (including institutional and home and community-based long-term-services and supports) based on medical necessity and clinical criteria to beneficiaries eligible under the state plan and to the demonstration populations.

1147 is the State's process to evaluate level of care. Assessment date: - Day patient assessment was completed by a physician, APRN, or RN • LOC start date: - Must be on or after the assessment date (up to 60 days).

Hawaii has two medical assistance programs called Hawaii QUEST and Medicaid Fee-For-Service. Hawaii QUEST, commonly known as QUEST is a program that provides health coverage through health plans for eligible Hawaii residents. It provides medical and mental health services.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232