Get Sandhills Center Verification Of Relative/legal Guardian As Direct Support Employee 2018-2025

Completing the Sandhills Center verification form is essential for ensuring compliance with regulations that support individuals with mental health, intellectual/developmental disabilities, and substance abuse services. This guide will walk you through the process of filling out this form online, step by step.

Follow the steps to complete the verification form accurately.

1. Click the ‘Get Form’ button to access the verification document and open it in a suitable editor.
2. Fill in the date of submission, the name of the network provider agency or employer of record, and the contact details including the contact name, address, email, and phone number.
3. Enter the beneficiary’s name, age, and date of birth. Make sure to specify the county from which the beneficiary’s Medicaid originates and provide the care coordinator’s name.
4. Indicate whether the member is living in their natural home by selecting 'Yes' or 'No'.
5. Provide the prospective employee's name, their relationship to the beneficiary, and confirm if they are a legal guardian.
6. Confirm the guardian's legal ability to provide services as outlined in HB 543, and check if the relative or legal guardian lives in the same home as the member.
7. Specify the total hours of community living and support requested per week, and confirm who will provide the necessary backup staffing.
8. Complete the justification section by attesting that no other qualified provider is available to provide the service. Describe planned actions to ensure the member is not isolated from the community.
9. If this is an annual recertification, provide the month and year the relative/legal guardian was hired and state if they worked with another provider prior to this agency.
10. Review the monitoring requirements section to confirm understanding of the oversight protocols for the provision of services.
11. All parties involved must sign the document to certify that the provided information is true and accurate. Ensure to include names, relationships, and dates as required.
12. Once all fields are completed and verified for accuracy, save your changes, and prepare to print or share the completed form. Remember that original documents must be mailed to the designated department.

Complete your documentation online today to support compliance with the Sandhills Center guidelines.