Get Dhcs 7096

The Dhcs 7096 is an essential form used for waiver referrals within the California Department of Developmental Services. Completing this form accurately is crucial for eligibility determination regarding Medi-Cal services. This guide will provide you with clear, step-by-step instructions on how to fill out the Dhcs 7096 online effectively.

Follow the steps to successfully complete the form

1. Select the ‘Get Form’ button to retrieve the Dhcs 7096 form and open it in your preferred editor.
2. Begin by entering the case name, case number, worker name, and worker number in the designated sections at the top of the form.
3. In the section labeled ‘California Regional Center,’ input the name of the applicant, their address, city, state, social security number, date of birth, and telephone number.
4. If applicable, provide the parent or guardian's name and their address, city, state, and ZIP code in the appropriate fields.
5. For the status section, indicate whether the applicant is a new Medi-Cal applicant or currently receives Medi-Cal by checking the corresponding box.
6. In the living arrangement section, specify where the applicant is currently located by selecting the appropriate option, including anticipated discharge dates if applicable.
7. Ensure to include the signature of the Regional Center contact person along with their printed name, title, and telephone number.
8. Finally, review all entered information for accuracy. Once verified, save the changes to your document, and prepare for downloading, printing, or sharing the completed form.

Complete your Dhcs 7096 online today to ensure the proper processing of your waiver referral.