Get Anything Form

Filling out the Anything Form online can be a straightforward process when guided through each section. This guide aims to provide clear, step-by-step instructions to help users complete the form accurately.

Follow the steps to fill out the Anything Form effortlessly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the member’s name exactly as it appears on the referral form. This is crucial to ensure that all details align with existing records.
3. Enter the member’s MaineCare number in the designated field. Double-check this number to avoid any processing delays.
4. Choose one of the options for attachment: either the HCFA 485 plan of care signed by the member’s physician or the physician orders. Ensure that this documentation is completed and included when requesting an assessment.
5. Provide a clear statement explaining why the required services are not accessible to the member on an outpatient basis. This is important for authorization reasons.
6. Specify if the member's condition requires skilled nursing care on a 'part-time' or 'intermittent' basis, or therapy services as defined in Section 40.02-3 (E).
7. Indicate the Start of Care Date for assessment or management, using the format MM/DD/YYYY.
8. Sign the attachment in the appropriate space to confirm completion of the form.
9. Enter the date that this attachment was completed in the designated field.
10. Include your provider agency name in the specified area to identify the responsible entity.
11. Finally, fax the completed referral attachment along with the referral form and plan of care to Goold Health Systems at 800-368-0965.

Complete your documentation online today to ensure smooth processing of your requests.