Follow the steps to accurately complete the form.

1. Click ‘Get Form’ button to initiate the process and access the document for online completion.
2. Begin by entering the home or provider’s name in the designated field at the top of the form. Ensure it matches the official name of the adult family home.
3. Next, input the date the form is being filled out. This should reflect the current date to maintain up-to-date records.
4. Enter the license number of the adult family home, ensuring it is accurate as this helps identify the specific provider.
5. Review the section regarding Medicaid information. Clearly indicate whether the home accepts Medicaid payments based on the outlined conditions.
6. Complete the admission fee section if applicable, ensuring that any required admission fees are clearly disclosed.
7. Fill out the deposits section by specifying the deposit purpose and the amounts required, ensuring transparency.
8. Enter details for any prepaid charges, including their purposes and amounts. Clear documentation is crucial.
9. Document any other fees or charges associated with the home, ensuring to specify their purposes and amounts.
10. Complete the daily and/or monthly rates section, providing a full range of charge options based on the services and care needed.
11. Detail the personal care services offered, indicating additional charges based on the levels of assistance required.
12. Fill out the medication and medical services offered, including any relevant charges that may apply.
13. Document any additional services and items not included in the daily or monthly rates and their associated costs.
14. At the end of the form, review all entries to ensure accuracy and completeness. After verification, you can choose to save changes, download, print, or share the completed form.

Start filling out the Disclosure Of Charges Afh online today to gain insight into the costs and services of adult family homes.