Get Mi Dhhs Dch-3877 2022-2025

The MI DHHS DCH-3877 form is essential for identifying individuals who may require mental health services upon admission to a nursing facility. This guide provides step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to fill out the MI DHHS DCH-3877 form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section 1 where you need to indicate if this is a Preadmission Screening (PAS) or an Annual Resident Review (ARR) by checking the appropriate box and noting any change in condition or hospital exempted discharge.
3. In Section 2, provide the patient’s information, including their name, date of birth, gender, address, and social security number. Make sure to fill in all required fields accurately to avoid delays.
4. Indicate whether the patient has a court-appointed guardian or another legal representative. If yes, provide their details, including name, county, and contact information.
5. Complete the referring agency and nursing facility information, including names, addresses, and telephone numbers as necessary for processing.
6. Proceed to Sections 3 and 4, which must be completed by a qualified clinician. Ensure that all six screening criteria are addressed and that accurate information regarding the patient's mental health diagnosis and treatment is provided.
7. Clinicians should review the criteria and confirm all responses. Section 4 requires clinician certification, so ensure their signature, date, and license details are correctly entered.
8. Once the form is fully completed, users can save changes, download, print, or share the form as needed for submission to the appropriate agency.

Complete the MI DHHS DCH-3877 form online today to ensure timely processing for admission.