Get Ia Dhs 470-4389 2009-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the IA DHS 470-4389 online
The IA DHS 470-4389 form is essential for documenting the services provided through consumer-directed attendant care. This guide will help you navigate each section of the form online, ensuring you accurately record the necessary information.
Follow the steps to complete the form effectively.
- Click ‘Get Form’ button to obtain the form and open it in the designated online space.
- In the first field, enter your provider name, including your first name, middle initial, and last name.
- If applicable, provide the agency name in the second field, ensuring it identifies your agency clearly.
- For the daily date of service, select or input the month, day, and year when the service was rendered.
- Record the consumer’s name in the fifth field, using their first name, middle initial, and last name.
- Enter the consumer’s Medicaid ID number in the next section.
- Indicate the locations where you performed the service, such as home, school, or work.
- Provide the start and end times of your service in the time section, ensuring to mark am or pm accurately.
- In the service code field, select and enter the appropriate code that corresponds to the service you provided, from the list provided.
- Document the actual hours of CDAC services you provided in the next field, including hours and minutes.
- Describe the services you performed for the consumer in detail.
- In the following box, describe the consumer’s response to the services you rendered.
- Calculate and enter the total hours of service provided, if using multiple forms, total the hours for each individual form separately.
- Sign the form with your provider signature.
- Lastly, enter the date on which you are signing the form; it should match the date of service you've recorded earlier.
Complete your IA DHS 470-4389 form online today to ensure accurate and comprehensive service documentation.
To contact DHS SNAP in Iowa, you can call your local DHS office or visit their website for additional resources. The department provides various ways to connect, ensuring that you receive timely assistance. If you need more structured help with IA DHS 470-4389, you can also access tools on the US Legal Forms site aimed at making your communication with DHS smoother. It's vital to reach out, as they are there to help you with your SNAP inquiries.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.