Get Epd Waiver Transfer Form - Dhcf Dc

This guide provides comprehensive instructions on how to complete the EPD WAIVER TRANSFER FORM for the Department of Health Care Finance in Washington, D.C. The form is essential for transferring care between providers and is designed to ensure that users receive the appropriate services without interruption.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to obtain the EPD WAIVER TRANSFER FORM and open it in your online editor.
2. Begin by filling in the beneficiary's details, including their full name and Medicaid ID number. Ensure the information is accurate to facilitate the transfer process.
3. Provide the details of the discharging provider. This includes their name, address, phone number, and email. You can select the appropriate agency from the drop-down menu.
4. Next, specify the waiver services that are to be transferred. You will need to select the service type and frequency, as well as any associated costs if applicable.
5. Indicate the reason for the transfer and select the type of transfer from the options available.
6. Complete the receiving provider section by inputting the relevant details such as the provider name, address, phone number, and email. Again, make use of the drop-down menus where applicable.
7. Review all information provided for accuracy before finalizing the form. Make sure to check any notes or instructions specific to your situation.
8. Once all required fields are filled, you can save your changes, download the form, or print it directly for submission.

Complete your EPD WAIVER TRANSFER FORM online today to ensure a smooth transition of care.