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Get FL Instructions for Completing the AHCA MedServ-3008 Form 2009-2022

E during hospitalization Indicate certification of individual in need of Medicaid Waiver Service in lieu of institutional care placement List effective date for certification Print name, address, and phone number of physician MD/DO must sign and date form as mandated by federal law Section K: The Nursing/Social Work Assessment Form • Activities of Daily Living (ADLs) are at the time of admission into the nursing facility • (*) Indicates “Hands on is needed” for this ADL • Check approp.

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