Get Ca Access Tlc Hcba Waiver Application 2021-2025

This guide provides clear, step-by-step instructions for filling out the CA Access TLC HCBA Waiver Application online. Whether you are a first-time user or familiar with the process, this guide will help you navigate the application efficiently.

Follow the steps to successfully complete the application.

1. Click ‘Get Form’ button to access the CA Access TLC HCBA Waiver Application and open it in your editing interface.
2. Begin by entering the applicant’s name and contact information in the designated fields. Include the home phone number and marital status, then proceed to provide the date of birth and age.
3. Specify the applicant's gender by selecting one option from the provided choices: Male, Female, Transgender M to F, or Transgender F to M.
4. Indicate the county of residence and the current living situation of the applicant, selecting one option from: At home, Hospital, Nursing Facility, or Other. If choosing Hospital or Nursing Facility, fill in the dates of admission and estimated discharge, along with the number of consecutive days in care.
5. Input the current mailing address of the applicant, ensuring accuracy in the street, apartment/room number, city, and ZIP code fields. If the street address differs from the mailing address, provide it in the next section.
6. Complete the section regarding health care insurance. Indicate if the applicant has Medi-Cal, Medicare, or other insurance, providing relevant policy numbers where applicable.
7. List the applicant’s current medical diagnoses and check applicable boxes to identify their medical needs. You can specify additional needs in the space provided.
8. Address any specific medical instruments or equipment the applicant requires and any chronic pain treatments, as described in the form.
9. Identify who holds the legal authority for the applicant’s health care decisions, providing necessary details if this authority lies with someone other than the applicant.
10. Complete the service provider section, listing all current providers and detailing the types of services received by the applicant.
11. Once all sections have been completed, review the information for accuracy. Save the changes, then download, print, or share the application as needed before submission.

Complete your CA Access TLC HCBA Waiver Application online today to ensure timely processing of your request.