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DMAS-99 rev. 09/09. Page 1. This form contains patient-identifiable information and is intended for review and use of no one except authorized parties. Misuse .

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How to fill out the Community-Based Care Recipient Assessment Report online

The Community-Based Care Recipient Assessment Report is essential for evaluating the needs of individuals receiving care services. This guide provides clear, step-by-step instructions to assist you in completing the report accurately and efficiently online.

Follow the steps to complete the assessment report thoroughly.

  1. Click ‘Get Form’ button to obtain the assessment report and open it in your preferred editing platform.
  2. Begin by filling in the recipient’s details. Enter the recipient’s name, date of birth, Medicaid ID number, current address, phone number, and the provider agency’s name.
  3. Specify the assessment type by checking the appropriate box for either initial visit, routine visit, or six-month re-assessment.
  4. Complete the functional status section. For each activity of daily living (ADL), indicate the level of assistance required by selecting the corresponding option.
  5. In the medical and nursing information section, provide details about the recipient’s diagnoses, medications, health status, current medical nursing needs, therapies, and any hospitalizations.
  6. Document the support system utilized by the recipient. List any waiver services, total weekly care hours, and the primary caregiver's information.
  7. If applicable, fill out sections specific to either consumer-directed or agency-directed services, providing additional details as required.
  8. Ensure that the supervisory visit details are accurately recorded, including the frequency of visits and any issues with care provision.
  9. Review all sections for completeness and accuracy before saving your changes. If necessary, you can download, print, or share the report once completed.

Get started on filling out the Community-Based Care Recipient Assessment Report online today.

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About the Agency The mission of the Virginia Department of Medical Assistance Services (DMAS) is improving the health and well-being of Virginians through access to high-quality health care coverage.

This covered group is for Virginians who are Aged, Blind, or Disabled, and who have income at or below 80% of the Federal Poverty Level (FPL). This group, like other ABD groups, must meet resource requirements, too. The “ABD ≤80% FPL” group receives full Medicaid benefits.

Income & Asset Limits for Eligibility 2023 Virginia Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleMarried (both spouses applying)Medicaid Waivers / Home and Community Based Services$2,742 / month†$5,484 / month†Regular Medicaid / Aged Blind and Disabled$972 / month$1,315 / month2 more rows • Jun 20, 2023

Who is eligible for Virginia Medicaid? Household Size*Maximum Income Level (Per Year)1$19,3922$26,2283$33,0644$39,9004 more rows

"DMAS" or "the department" means the Virginia Department of Medical Assistance Services. "DMAS-225" means the Medicaid Communication form used for the provider and the DSS eligibility worker to report changes including requests for adjustments to the patient pay.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232