Get Wa Dshs 15-449 2021-2025

Filling out the WA DSHS 15-449 form is an essential step for those seeking transparency in adult family home charges. This guide provides a clear and structured approach to completing the form effectively, ensuring that users can navigate its components with confidence.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the WA DSHS 15-449 form online. This will open the document in your preferred digital editor.
2. Begin with the provider's name and home information by entering the name of the adult family home as listed on your documents.
3. Fill in the date and license number of the home to ensure accurate identification.
4. Read the introductory note carefully, which outlines the purpose of the form and the importance of contacting the home directly for further information.
5. Navigate through the sections such as Medicaid information, admission fees, and various charges. Complete each section by filling in any relevant amounts or details as applicable to the services provided by the home.
6. For personal care, medication services, and other services, specify the rates charged. Be diligent to indicate whether these costs are included in the daily or monthly rates.
7. Complete the section for acknowledgments where the resident or their representative acknowledges receipt of the charges by signing and dating the document.
8. Review the entire form for accuracy and completeness, ensuring all required fields are filled.
9. Once you have confirmed that all information is correct, save the changes, download the completed form, or print it for your records.

Make sure to complete and submit your WA DSHS 15-449 form online today for a clear understanding of charges in adult family homes.