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COMMONWEALTH OF PENNSYLVANIA OFFICE OF LONG TERM LIVING Bureau of Participant Operations SERVICE PROVIDER CHOICE FORM Name (Last, First, Middle): Address: County: Before you choose who will be providing.

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The following tips will help you fill out Service Provider Choice Form quickly and easily:

  1. Open the form in our feature-rich online editing tool by clicking Get form.
  2. Complete the requested fields which are marked in yellow.
  3. Hit the green arrow with the inscription Next to move from field to field.
  4. Use the e-autograph tool to add an electronic signature to the form.
  5. Insert the relevant date.
  6. Read through the entire e-document to be sure that you haven?t skipped anything.
  7. Press Done and download your new document.

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