Get Dhs 6037

The Dhs 6037 is a crucial document used for communication between managed care organizations, counties, and tribal agencies. This guide will provide clear, step-by-step instructions on how to fill out the form online, ensuring the seamless transfer of information for individuals receiving home and community-based services.

Follow the steps to complete the Dhs 6037 form successfully.

1. Click the ‘Get Form’ button to access the Dhs 6037 document and open it in your preferred online editor.
2. Enter today's date in the designated field at the top of the form. This informs the agencies of the current date for record-keeping purposes.
3. Fill in the 'To' field with the new lead agency's name and the 'Date of Transfer' for accurate processing.
4. Indicate the reason for transfer by checking all applicable boxes (e.g., change of county of residence, change in financial responsibility, etc.).
5. Complete the 'From' field with your current lead agency’s name. Then, provide the name, phone number, fax number, and email address of the current case manager or care coordinator.
6. Input the member or client’s full name, PMI number, home address, date of birth, and phone number, including their mailing address if it differs from the home address.
7. Specify the preferred language and indicate if an interpreter is needed by selecting the preferred option.
8. Provide information regarding the client's current residency in a hospital, nursing facility, or intermediate care facility, checking the appropriate yes/no boxes.
9. List the client's current waiver, AC, or ECS case manager name, financial worker name, case manager phone, and email address.
10. Detail any primary or secondary diagnoses, including the relevant ICD codes, as well as any mental health or developmental diagnosis codes.
11. Complete the community support plan section, detailing both formal and informal services or supports the client is receiving.
12. Attach any necessary documents, including recent assessments, and make sure to review all information for accuracy.
13. Once completed, make sure to save your changes before downloading, printing, or sharing the form with the respective agencies.

Complete your Dhs 6037 form online today to ensure timely processing of information.