Loading
Get Ar Dhs-703 2003-2026
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the AR DHS-703 online
The AR DHS-703 form is a vital document used for evaluating medical need criteria within various waiver programs. This guide will walk you through the process of filling out the form online, ensuring you provide accurate and necessary information.
Follow the steps to complete the AR DHS-703 online effectively.
- Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
- Begin by indicating whether this form is for an assessment (new application) or a reassessment (UR). Select the appropriate option accordingly.
- In Part I, fill in the name of the nursing facility if applicable and denote the client’s place of origin prior to the nursing facility. Make sure to provide the client’s date of admission.
- Complete the client’s personal information, including their full name, date of birth, social security number, and current residence. Ensure accuracy to avoid processing delays.
- Indicate the marital status of the client and answer whether they have been in a nursing facility before. If affirmative, include the discharge date if applicable.
- Under 'Continence Status', assess the client's bladder and bowel control. Record if assistance is needed and its frequency.
- Next, evaluate the client's nutritional status, indicating their height, weight, and any relevant dietary needs.
- Provide information in the sections for hearing, vision, speech/language, and skin condition. Specify any difficulties or treatments as necessary.
- After reviewing the mental status and orientation level, assess any major impairments and their implications on the client’s need for care.
- In Part III, list medications and treatments, durable medical equipment, and provide comments as necessary. Complete the prognosis and diagnosis sections as required.
- Finally, obtain the necessary signatures from the client or legal guardian, witness (if required), and the examining physician. Save your changes, then download, print, or share the form as needed.
Complete the AR DHS-703 online to ensure your or a loved one's needs are appropriately evaluated.
To apply for Medicaid, you generally need items such as income verification, identification documents, and proof of residency. Each state has different requirements, so it is vital to consult the AR DHS-703 form for specifics. Leveraging tools available on USLegalForms can simplify the process of assembling the right documentation for your application.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.