Get Ltc-34

The LTC-34 is a critical form used for assessing eligibility for long-term care services in New Jersey. Completing this form accurately is essential for ensuring appropriate care and support for individuals who may need nursing facility services.

Follow the steps to complete the LTC-34 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section 1, which requests identifying information. Fill in the patient's name, social security number, address, date of birth, and county of residence. Ensure all details are accurate and up-to-date.
3. Proceed to Section 2. Answer the questions regarding the patient's history of mental illness or developmental disabilities. Mark 'Yes' or 'No' as appropriate and include dates and outcomes for any required screenings.
4. In Section 3, provide insurance information. Fill out the Medicare number, indicate coverage details, and answer the questions about other insurances and pending Medicaid applications.
5. Section 4 focuses on cognitive status and activities of daily living. Carefully evaluate and denote the patient's decision-making ability, memory recall, self-expression, and performance in daily living tasks by selecting the appropriate responses.
6. In Section 5, document any diagnosis and specify if the patient has a condition that may require long-term care services. Include details about any catastrophic or chronic illnesses.
7. For Section 6, assess the patient's financial situation, including income and assets. Clearly indicate if the patient's income meets the Medicaid criteria and check the applicable boxes regarding resources.
8. Section 7 outlines the initial plan of care. Provide necessary information about supportive services and indicate the patient's choice of settings for care. Capture consent from the patient or their authorized representative.
9. Complete Section 8, where the certified assessor attests to the information collected. Include the assessor's details, signature, and date of completion.
10. After reviewing the form for completeness, save your changes and prepare to download or print the document. Ensure all three pages are included before submission.

Complete the LTC-34 and other required documents online for a smooth submission process.