Get Nhtd Referral Form

Filling out the Nhtd Referral Form online is a vital step in accessing home and community-based services through the New York State Medicaid waiver program. This guide provides a clear, step-by-step approach to help users navigate each section of the form effectively, ensuring they provide all necessary information accurately.

Follow the steps to complete the Nhtd Referral Form online:

1. Click the ‘Get Form’ button to access and open the Nhtd Referral Form in your online editor.
2. Begin by filling in the referral information. Input the referral number and the date of the initial referral in the specified format.
3. Complete the applicant's information section. Include the applicant's name, date of birth, current location, and their current telephone number.
4. Indicate if the applicant's Medicaid is active by selecting ‘Yes,’ ‘No,’ or ‘Unknown.’
5. Provide details about the applicant’s living situation under the current location options (e.g., private residence, nursing home). Also, include the address information.
6. Answer questions regarding the applicant's language proficiency and any required translation or interpretation services, if applicable.
7. Fill out the contact information for either a legal guardian or a contact person, depending on the situation.
8. In the demographics section, indicate the applicant's age, sex, marital status, and other relevant personal details.
9. Report the primary diagnosis and areas of concern, along with the living arrangements and support currently in place.
10. Complete the referral source section, including whether it is a self-referral or formal referral, and provide necessary contact details.
11. Finally, review all entries for accuracy before saving, downloading, printing, or sharing the completed form.

Start filling out the Nhtd Referral Form online today to ensure timely access to essential services.