Get La Bhsf Form 90-l 2018-2025

Completing the LA BHSF Form 90-L online can streamline the process of requesting medical eligibility determination. This guide will provide you with step-by-step instructions to ensure accurate and efficient completion of each section of the form.

Follow the steps to effectively fill out the LA BHSF Form 90-L online.

1. Press the ‘Get Form’ button to access the form and open it in your selected online editor.
2. In the Recipient Information section, fill in the recipient’s name, social security number, and Medicaid number. Complete the address including city, state, zip code, and parish. Ensure the responsible party’s information is also provided accurately.
3. Next, indicate the living arrangements by selecting the appropriate option (own home, relative’s home, etc.) and provide a contact number for the responsible party. Include the date of birth and any previous facility care received.
4. In the Level of Care section, the attending physician must indicate the required level of care needed by selecting the appropriate options. Note if home/community-based services are adequate for the patient’s needs.
5. Fill out the Medical Information section, including the diagnosis, medications (detailing dosage and frequency), and any allergies. Ensure to list recent hospitalizations and any relevant mental status or behavior observations.
6. Complete the Activities of Daily Living by checking the appropriate boxes, providing details on any special care or procedures needed.
7. In the Physical Examination section, record height, weight, pulse, respiration, temperature, and blood pressure. Include any lab results and comments on the general health examination.
8. A physician’s signature is required in this section; ensure to print the physician's or nurse practitioner's/physician assistant's name and appropriately sign the document with the date.
9. Once all sections are completely filled out, review the form for accuracy. You can then save your changes, download, print, or share the completed form as necessary.

Start filling out the LA BHSF Form 90-L online today to ensure a smooth application process.