Get Waiting List Entry/change Form Instructions 10/01/09 The Waiting ... - Dphhs Mt

Filling out the Waiting List Entry/Change Form is a crucial step in placing an individual on the waiting list for Developmental Disabilities Program services or updating their current status. This guide provides clear, step-by-step instructions to ensure that users can complete the form accurately and effectively.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it for electronic entry.
2. Select 'New', 'Update-Change', or 'Update-No change' based on the individual's status. Mark 'New' if the person is not on the waiting list, 'Update-Change' if you are updating with changes, or 'Update-No change' if there are no changes.
3. Enter the individual's full name, ensuring consistency in spelling.
4. Input the Developmental Disabilities eligibility date as determined by the DDP Quality Improvement Specialist.
5. Enter the Social Security number using the required format, dashes included, for example: 999-99-9999.
6. Fill in the birth date in the format month/date/year, such as mm/dd/yyyy.
7. Assign the AWACS ID number, which is a required field.
8. Indicate the MONA EICP amount by checking the appropriate box and entering the corresponding amount.
9. Report the Current ICP minus transportation if applicable, or enter '0' if not receiving DDP ICP services.
10. Mark the relevant Community Support Services if the individual is in those services by checking 'CS', 'MDC', or 'FES'.
11. Check the Medicaid eligibility status by selecting 'Y', 'N', or 'U' based on the individual's situation.
12. Enter the name of the assigned Case Manager or Family Support Specialist.
13. Record the individual’s residential address, including City and Zip code.
14. Indicate the gender by entering 'Male', 'Female', or 'unknown'.
15. Complete any desired information for Ethnicity, Tribe, and other optional fields.
16. Under 'Place on the waiting list for the following services,' indicate the desired start date for each service, ensuring compliance with eligibility requirements.
17. Choose between 'Waiting' or 'Planning' based on the desired start date and submit the required referral if necessary.
18. Fill out the desired locations for services, providing your top three preferences.
19. After filling out all required and desired fields, save your changes, download, and keep a printed copy for your records.

Complete your document and submit the Waiting List Entry/Change Form online today.