Get Sfn 616 Form - Fill Online, Printable, Fillable, Blank Pdffiller

The Sfn 616 form is an essential document for individuals seeking personal care services. This guide provides a comprehensive overview of how to fill out the form effectively, ensuring that users can navigate each section with ease.

Follow the steps to complete the Sfn 616 form smoothly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out Section I, Client Information. Enter the client's last name, first name, middle name, and identification number. Ensure the physical address, county of residence, city, state, and ZIP code are accurate.
3. In Section II, Personal Care Services Eligibility, indicate the qualification type (PCS - A, B, or C) and mark the appropriate options for rural differential, if applicable. Assess the client's activities of daily living (ADLs) by scoring each item accordingly.
4. Continue to Section III, Approved Services. Provide the provider number, name of the PCS provider, and indicate the total number of units or days authorized for billing. Check relevant boxes regarding case management services.
5. In Section IV, Other Services, provide any additional service and provider information as necessary.
6. Proceed to Section V, Signatures. Indicate if services have been reduced and provide the reason. Ensure the client or their legal representative signs the document along with the case manager.
7. Finally, review all sections for completeness. Save your changes, download a copy for your records, print the form, or share it as required.

Complete your Sfn 616 form online today for a streamlined process.