Get Nursing Home Tansition And Diversion Medicaid Waiver Manual - Waiver Contact List Form. Appendix

Filling out the Nursing Home Transition And Diversion Medicaid Waiver Manual - Waiver Contact List Form can be an essential step in ensuring the smooth transition into community-based living. This guide provides a clear, step-by-step approach to assist you in completing the form efficiently.

Follow the steps to complete the waiver contact list form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering the date at the top of the form. This provides context for when the information is collected.
3. Fill in the participant's name. Ensure that the information is accurate and matches relevant documentation.
4. In the service coordinator section, provide the name and telephone number of the assigned service coordinator. This contact is vital for follow-up discussions.
5. Next, input the supervisor’s name and telephone number for the service coordinator. This establishes a secondary contact for inquiries.
6. Complete the provider agency section, including the agency's full name for clarity.
7. Proceed to the regional resource development specialist section, filling in their name and telephone number, along with the supervisor's details.
8. Continue with the quality management specialist section, providing their name and telephone number, and including the supervisor’s contact details.
9. In the service area, list the specific services provided. For each service, include the corresponding agency name, staff name, and supervisor's name.
10. If additional services are needed, make sure to fill in multiple service sections as outlined. Use the blank lines provided to ensure all necessary information is captured.
11. Once all fields are completed, review the document for accuracy to ensure that all information is correctly entered.
12. You can then choose to save your changes, download the completed form, print it, or share it with the necessary parties.

Start filling out your form online today to ensure timely processing of your services!