Get 912 - Dphhs Home - Dphhs Mt

Filling out the 912 - DPHHS Home - Dphhs Mt form online can seem challenging, but this guide will walk you through each step thoughtfully and clearly. By following these instructions, you will ensure that your form is completed accurately and efficiently.

Follow the steps to effectively complete the form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Begin by entering the employee name in the designated field. If applicable, select the relevant program from the options provided, such as AB-CFC, SD-CFC, or HCBS.
3. Fill in the member name and Medicaid ID, ensuring that all information is accurate to avoid processing delays.
4. Indicate the pay period by entering the relevant dates in the specified format (Mo/Day/Yr).
5. Record the odometer readings for each trip under the respective sections for shopping and community integration, including both the start and end points.
6. Under 'Shopping,' provide the date, location, and odometer readings. Ensure that the last three digits of the odometer readings are filled in as required.
7. Repeat the process for the community integration section, noting the details for each trip and the total miles traveled.
8. For medical escort services, document the dates, times, healthcare provider names, locations, total time taken, and total miles for each appointment.
9. In the comments section, include any additional notes if needed, providing context or clarifications regarding the recorded entries.
10. Finally, ensure that all required signatures are completed: employee, member or personal representative, and agency representative. Once finished, save your changes to the document.
11. Download, print, or share the completed form as needed to submit it to the relevant parties.

Take the time to complete your documents online to streamline your process and ensure accuracy.