Get Map 350

The Map 350 is an essential document for planning and authorizing waiver services. This guide will provide clear, step-by-step instructions for filling out the form online, ensuring you can complete it accurately and efficiently.

Follow the steps to complete the Map 350 online.

1. Press the ‘Get Form’ button to obtain the Map 350 and open it in your browser.
2. Begin by entering the member's full name in the designated fields, including last, first, and middle initial.
3. Input the Medicaid member ID number, followed by the date of birth and the complete address, including street, city, state, zip code, and county.
4. Record the home phone number for the member, and provide details for the case management or support broker agency, including their phone information.
5. If applicable, enter the name of the guardian, their relationship to the member, and their phone number.
6. Fill in the power of attorney details, including their name, relationship to the member, and phone information.
7. For individuals using Consumer Directed Options (CDO), provide the representative's name and their relationship.
8. Input the primary caregiver's information, including name, relationship, address, and phone number.
9. Identify the needs, outcomes, services, and providers relevant to the member's care, ensuring each goal and objective is noted.
10. Complete the support spending plan by filling out the service codes, provider names, units of service, costs per unit, and total monthly expenses.
11. Draft the clinical summary and emergency backup plan if applicable, ensuring all information is reflective of the member's needs.
12. Finally, gather signatures for the member or guardian, case manager/support broker, and any necessary representatives, along with date markings.
13. Review the filled-out form for accuracy and completeness, then save your changes, download the form, or print to share as needed.

Start completing your Map 350 online today to streamline your waiver service planning.