Get Map 409

Filling out the Map 409 form online is an essential step in the pre-admission screening process for nursing facility admission in Kentucky. This guide will provide clear, step-by-step instructions on how to complete each section of the form, ensuring that users can navigate the online process with ease.

Follow the steps to successfully complete the Map 409 online

1. Press the ‘Get Form’ button to access the Map 409 and open it in your editor.
2. Begin with the applicant's details. Fill in the applicant’s name (last and first), address, Social Security number, city, state, date of birth, and zip code in the respective fields provided.
3. Move to Section I, which pertains to criteria for mental illness. Carefully read each requirement and select 'Yes' or 'No' for the diagnosis, level of impairment, and recent treatment as applicable.
4. Proceed to Section II if applicable, regarding mental retardation and related conditions. Answer the questions referring to the individual’s intellectual functioning and relevant evidence.
5. Review the criteria for exceptional admission outlined in Section IV. Indicate any specific conditions that may warrant exemption from a Level II PASRR.
6. Complete the routing section by providing the names and contact information of any individuals who offered history for the applicant, if necessary.
7. Finally, ensure that the form is signed, providing the title, date, telephone number, and facility name. After confirming all information is accurate, select the appropriate options to save, download, print, or share the completed form.

Complete your documents online today for a smoother application process.