Get 470 5044 Service Worker Comprehensive Assessment Form

The 470 5044 Service Worker Comprehensive Assessment Form is crucial for assessing your medical and daily care needs. Completing this form accurately is essential for determining eligibility for home- and community-based services. This guide will walk you through the form-filling process step-by-step to ensure clarity and comprehension.

Follow the steps to complete the form online effectively.

1. Click ‘Get Form’ button to acquire the form and open it for editing.
2. Begin by filling out personal information, including your name, date of birth, Medicaid ID number, and contact details. Ensure all fields are filled accurately.
3. Complete the section concerning your living situation. Indicate if you live alone and provide details about household members, their relationships with you, and any changes in the last year.
4. Provide details regarding your medical care, including your doctors’ names and contact information, as well as a list of any therapies or medical services you receive.
5. In the assistive devices and medical conditions sections, indicate usage and assistance required. Detail the frequency of use and the person providing help if applicable.
6. Complete the activities of daily living section by indicating the level of assistance needed for each activity. Provide descriptions of who helps and how often assistance is required.
7. For children, fill in the relevant sections about the child's education and support needs, including details from the Individual Education Plan if relevant.
8. Once all sections are completed, review the narrative section to provide additional information about your daily life and care requirements.
9. Finally, certify your form by signing and dating it. Ensure you send it to the indicated address to complete the process.

Complete the 470 5044 Service Worker Comprehensive Assessment Form online today for prompt assistance with your care needs.