Get Department Of Behavioral Health And Developmental Disabilities - Dbhdd Georgia
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How to fill out the Department Of Behavioral Health And Developmental Disabilities - Dbhdd Georgia online
Completing the Department Of Behavioral Health And Developmental Disabilities (DBHDD) conversion form can help ensure that your provider information is accurately updated. This guide provides step-by-step instructions to assist you in filling out the form online effectively.
Follow the steps to complete the conversion form accurately.
- Click ‘Get Form’ button to access the conversion form and open it in the designated editor.
- Check the type of change being reported by selecting either Community Living Arrangement (CLA) or Personal Care Home (PCH).
- In the Current Provider Identification section, enter the name of your agency as it currently appears in the DBHDD records.
- For the Licensed Home Information section, input the name and address of the licensed home. Also, provide the telephone number and the current Georgia Medicaid Provider Number assigned to this home, along with the number of individuals currently receiving DD Residential Waiver Services at this location.
- In the Signatures section, ensure that the current provider, the licensed/host home provider, and the DBHDD regional office sign and date the form. All signatures are necessary for the change to be approved.
- If further clarification is needed, users may reach out to the DBHDD Office of Provider Network Management through the provided email address.
- After completing the form, return it along with any required attachments to the Provider Enrollment Unit, Office of Provider Network Management.
- Final actions include saving changes, downloading, printing, or sharing the form as necessary.
Start filling out your DBHDD conversion form online today!
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The primary agency for persons with disabilities in Georgia is the Department of Behavioral Health and Developmental Disabilities - DBHDD Georgia. This agency provides essential services designed to support the rights and needs of individuals with disabilities. They offer various programs that promote independence and community participation. If you seek resources or assistance, US Legal Forms can help you navigate the necessary forms and documents related to disability services.
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