Get Missouri Department Of Health And Senior Services Dhss Use

Completing the Missouri Department of Health and Senior Services Shared Care Registration form is essential for caregivers to register in the Shared Care Program. This guide provides clear, step-by-step instructions for filling out the form online to ensure a smooth process.

Follow the steps to fill out the Shared Care Registration form online.

1. Press the ‘Get Form’ button to access the Shared Care Registration form and open it in your chosen editor.
2. Begin by filling out the caregiver registration section. Enter your name as it appears on official documents — last name, first name, and middle initial. Provide your social security number without dashes.
3. In the address section, enter your complete physical address, including street, city, state, and zip code. Make sure the information is current.
4. Next, provide your telephone number where you can be reached and specify your county of residence.
5. Enter your date of birth in the format MM/DD/YYYY. Then select your race and sex based on your identification.
6. Proceed to the care recipient registration section. Fill in the care recipient’s name, social security number, and date of birth, similarly formatted. Also, indicate their race and sex.
7. Specify your relationship to the care recipient in the designated field.
8. Respond to each eligibility question by checking ‘Yes’ or ‘No.’ Ensure you read each question carefully to assess accuracy.
9. Input the name of the physician who will sign the Physician Certification form. Specify the date it was signed.
10. Finally, select the tax year for which you are registering.
11. Sign and date the form in the designated area to certify that all information provided is complete and accurate.
12. After you've filled out the entire form, save your changes. You can then download, print, or share the completed form as needed.

Complete your registration online today to ensure you are set up as a caregiver in the Shared Care Program.