Get Nv Form Fa-30 2017-2026

Filling out the NV Form FA-30 online is an important step for obtaining out-of-state nursing facility placement for individuals seeking Medicaid assistance. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the NV Form FA-30 with ease.

1. Click ‘Get Form’ button to access the form and open it in your editor.
2. Fill in the date of request at the top of the form, ensuring you use the correct format.
3. In Section I, provide the recipient's information, including their name, date of birth, age, Medicaid ID, and guardian details if applicable.
4. Indicate the marital status of the recipient and whether guardianship has been applied for.
5. In Section II, answer questions related to clinical information, including if the request is for ICF/IID and list any diagnoses and medications.
6. Complete the reason for seeking out-of-state placement by checking all relevant boxes and providing supporting documentation where necessary.
7. Fill in Section III with the servicing provider's information, including their name, contact number, and details about the case manager.
8. In Section IV, acknowledge and consent to the out-of-state nursing facility placement, providing necessary signatures and dates.
9. For Section V, confirm any burial plan details and provide the necessary signatures if applicable.
10. Finally, review the completed form for accuracy, and save your changes. You can then download, print, or share the form as needed.

Complete your NV Form FA-30 online today to ensure timely processing of out-of-state nursing facility placement requests.