Get Map 351

The MAP 351 is an essential form for the Medicaid Waiver Assessment in Kentucky. This guide aims to provide a comprehensive, step-by-step overview of how to fill out the form accurately and efficiently.

Follow the steps to complete the MAP 351 online.

1. Press the ‘Get Form’ button to access the MAP 351 and open it in your preferred online editor.
2. Begin by entering the member demographics in Section I. Provide the member's full name, address, date of birth, county code, sex, emergency contact information, and height and weight. Ensure all fields are filled accurately.
3. In Section II, indicate the type of Medicaid waiver program applied for by checking the appropriate box. Also, specify the type of application (Certification, Re-certification, or Re-application) and the delivery method for program services.
4. Proceed to Section III to provide information about the assessment provider. Include the provider's name, number, phone number, street address, and contact person details.
5. Section IV focuses on the member's self-assessment. Answer all questions regarding community inclusion, relationships, rights, dignity, health, and lifestyle, providing comments where necessary.
6. In Section V, assess the member's independence in activities of daily living (ADLs) such as dressing, grooming, bathing, and eating. Select the appropriate options and add comments to specify the level of assistance required.
7. Move to Section VI to evaluate the member's ability to handle instrumental activities of daily living (IADLs) like meal preparation, shopping, and managing finances. Fill out the necessary comments for clarity.
8. Complete Sections VII through XII as required, providing information on neuro/emotional/behavioral status, health care needs, household information, and any other relevant details.
9. Once all sections are completed, review the entire form for accuracy. Users can then save changes, download, print, or share the completed form as necessary.

Complete your MAP 351 form online today for timely processing.