Loading
Get Cares Program
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the CARES PROGRAM online
Filling out the CARES PROGRAM form is a crucial step for individuals seeking support and resources related to therapy. This guide provides clear instructions to help you successfully complete the form online.
Follow the steps to fill out the CARES PROGRAM form accurately
- Click the ‘Get Form’ button to access the CARES PROGRAM form and open it for filling out.
- Begin by providing your personal information in the appropriate fields, including your name, mailing address, city, state, ZIP code, phone number, mobile number, and email address. Make sure all details are accurate and up to date.
- Next, you'll need to fill in the caregiver's information. Include their name and phone number. This section allows the program to contact the designated caregiver, if necessary.
- You must sign the authorization section. By signing, you allow Actelion Pharmaceuticals and associated entities to use and disclose your protected health information (PHI) for the program's operation. Ensure that you read this section carefully.
- If the form is signed by a personal representative, that individual must complete the corresponding section, providing their name and relationship to the patient. They must also sign to confirm their authority to act on behalf of the patient.
- Review all information filled in on the form for accuracy and completeness. It is essential that all provided information is true, correct, and complete.
- Once you have verified the form, you can save your changes, download a copy for your records, or choose to print the form for submission.
- Finally, submit the completed form either by faxing it to 866-782-6163 or mailing it to the designated address provided in the form.
Take the first step towards participating in the CARES PROGRAM by completing your form online today.
The 85% rule in Florida relates to the percentage of residents in specific care programs who must meet particular standards for funding and support. This rule ensures that the services are efficiently delivered to those who need them most. By aligning with the CARES PROGRAM, providers can better navigate these requirements and maintain compliance.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.