Get Mfp Transition Screening Form - Georgia Department Of ... - Dch Georgia

The MFP Transition Screening Form is designed to assess the transition needs of individuals seeking to live in the community instead of a facility. This comprehensive guide offers clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully fill out the MFP Transition Screening Form.

1. Press the ‘Get Form’ button to access the MFP Transition Screening Form and open it for your review.
2. Begin by providing the participant's name in the designated field at the top of the form. It is important for the screener to establish rapport before proceeding.
3. Indicate whether the participant wishes to live outside of the facility by checking 'Yes' or 'No'. Fill in the screening type and date according to the applicable category and use the mm/dd/yyyy format.
4. Complete the demographics section, including gender, ethnicity, and primary language. This information is essential for understanding the participant's background.
5. Fill in the referral source by selecting an appropriate option from the list, and if necessary, specify any other source. Additionally, provide information about any referral to a waiver program.
6. If applicable, include any notes regarding refusal or ineligibility based on criteria mentioned in the form. This section captures essential considerations for the participant's transition.
7. Provide personal data, including Medicaid and Medicare numbers, the facility's name and address, and contact information for the discharge planner or contact person.
8. Indicate marital status and fill out the spouse's name and address if applicable. Additionally, note if the individual is a veteran and if a guardian is involved.
9. Respond to the questions about previous living arrangements, community ties, and support systems. Ensure to document wish lists for contacts who may assist in the transition process.
10. Complete the financial data section thoroughly, detailing income sources and resources, and indicating who is responsible for the current stay at the facility.
11. Address healthcare needs by providing relevant medical information, including disabilities, doctor contacts, and any assistance required with daily medications.
12. Assess functional needs by checking if assistance is required for daily activities. Document any unmet needs for help in the community.
13. Fill out the referral to home community-based services, including waiver application details and dates related to assessments and referrals.
14. Attach the required document checklist as noted in the instructions, ensuring copies of consent and relevant identification are included.
15. Finally, ensure the form is signed by the relevant personnel and submit it through appropriate channels, maintaining a record of submission.

Complete the MFP Transition Screening Form online today to initiate your transition process.